Individual
MS. KACEY RAE LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4801 AMBASSADOR CAFFERY PARKWAY, LAFAYETTE, LA 70508-3983
(337) 470-2605
(337) 470-4595
Mailing address
5959 S SHERWOOD FOREST BLVD, BATON ROUGE, LA 70816-6038
(225) 526-0636
(225) 765-9616
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
300080
LA
363AS0400X
Surgical Physician Assistant
300080
LA
Other
Enumeration date
10/01/2015
Last updated
06/26/2023
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