MEDICARE: KAYLA MOUCH RICHOUX

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	363LF0000X	Family Nurse Practitioner	AP09741	LA

General Provider Information

NPI Number	:	1962910836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA MOUCH RICHOUX

Provider Business Mailing Address
First Line	:	610 N JEFFERSON AVE
Second Line	:
City	:	PORT ALLEN
State	:	LA
Zip	:	70767-2414
Country	:	US
Telephone Number	:	225-267-6626
Fax Number	:

Provider Business Practice Location Address
First Line	:	610 N JEFFERSON AVE
Second Line	:
City	:	PORT ALLEN
State	:	LA
Zip	:	70767-2414
Country	:	US
Telephone Number	:	225-267-6626
Fax Number	:

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

Provider Enumeration Date	:	01/13/2018
Last Update Date	:	01/20/2020

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