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Organization
KENTWOOD FAMILY CLINIC LLC
Active
Organization
KENTWOOD FAMILY CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE HOWARD (CEO)
(337) 991-9276
Entity
Organization
Contact information
Practice address
919 AVENUE G, KENTWOOD, LA 70444
(337) 991-9276
(337) 991-9288
Mailing address
1509 DULLES DR, LAFAYETTE, LA 70506-3718
(337) 991-9276
(337) 991-9288
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
NULL
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
08/19/2015
Last updated
03/02/2020
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