Individual
MRS. KELLIE ROY BERTRAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
118 JJJ LN, SIMMESPORT, LA 71369-2180
(318) 941-5286
(318) 941-5284
Mailing address
8415 GOODWOOD BLVD, SUITE 105, BATON ROUGE, LA 70806-7851
(225) 765-5727
(225) 765-5728
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN096429 AP04315
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174882
—
LA
Enumeration date
12/19/2005
Last updated
05/01/2013
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