Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 024810 | LA |
NPI | 1124011879 |
---|---|
Provider Name | Dr. Nicole Lee Kerley-Mcguire |
First Address | Franklin, LA 70538-4124 |
Second Address | Houma, LA 70360-4050 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2005 |
Last Update Date | 25/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1575917 | (05) | LA |