Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 222196 | LA |
NPI | 1063031110 |
---|---|
Provider Name | Dr. Kelly L. Baquet |
First Address | New Orleans, LA 70122-5166 |
Second Address | New Orleans, LA 70122-5166 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2020 |
Last Update Date | 02/11/2021 |