Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 308434 | LA |
NPI | 1083034557 |
---|---|
Provider Name | Dr. Kelly Lanier Paulk |
First Address | New Orleans, LA 70121-2429 |
Second Address | Kenner, LA 70065-2489 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2014 |
Last Update Date | 05/08/2019 |