MEDICARE: KELLI MCMANUS APRN-CPNP-PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	AP208698	LA

General Provider Information

NPI Number	:	1942851654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI MCMANUS APRN-CPNP-PC

Provider Business Mailing Address
First Line	:	4630 AMBASSADOR CAFFERY PKWY
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70508-6949
Country	:	US
Telephone Number	:	337-456-6892
Fax Number	:

Provider Business Practice Location Address
First Line	:	1268 SOUTHAMPTON DR
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71303-3036
Country	:	US
Telephone Number	:	318-449-4886
Fax Number	:	318-449-4877

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2019
Last Update Date	:	09/05/2023

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