MEDICARE: SKIN10, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	363LP2300X	Primary Care Nurse Practitioner
2	261QM0850X	Adult Mental Health Clinic/Center
3	207NS0135X	Procedural Dermatology Physician
4	225700000X	Massage Therapist
5	207QA0505X	Adult Medicine Physician
6	207N00000X	Dermatology Physician
7	208D00000X	General Practice Physician
8	163WM0705X	Medical-Surgical Registered Nurse
9	208200000X	Plastic Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942028378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKIN10, LLC

Provider Business Mailing Address
First Line	:	3266 DRUSILLA LN STE A-6
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-1862
Country	:	US
Telephone Number	:	225-335-6800
Fax Number	:	225-325-3470

Provider Business Practice Location Address
First Line	:	3266 DRUSILLA LN STE A-6
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-1862
Country	:	US
Telephone Number	:	225-335-6800
Fax Number	:	225-325-3470

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	KAYCE LAURIE
Credential	:
Telephone Number	:	225-978-8444

Provider Enumeration Date	:	10/03/2024
Last Update Date	:	09/09/2025

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Directions to “SKIN10, LLC ” Practice Location

Language	Start Address	Practice Location

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