# LAKESIDE FAMILY MEDICINE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083879225
- **Authorized official:** KAY NELSON M.D. (PHYSICIAN/OWNER)
- **Authorized official phone:** (318) 256-6465

## Contact information

- **Practice address:** 12060 TEXAS HWY, MANY, LA 71449-5605
- **Practice address phone:** (318) 256-6465
- **Mailing address:** 12060 TEXAS HWY, MANY, LA 71449-5605

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 12198R | LA | Yes |

## Other

- **Enumeration date:** 07/28/2008
- **Last updated:** 07/28/2008