Individual
MR. KEITH OWEN BREAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
401 E VAUGHN AVE, RUSTON, LA 71270-5950
(318) 254-2100
(318) 254-2728
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(800) 893-9698
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
207900
LA
Other
Enumeration date
06/11/2019
Last updated
12/19/2019
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