Organization
MOSS STREET KID MED LLC
Active
Organization
MOSS STREET KID MED LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DESIREE P RICHARD RN (ONWER)
(337) 291-2411
Entity
Organization
Contact information
Practice address
1417A MOSS STREET, LAFAYETTE, LA 70501
(337) 291-2411
(337) 291-2412
Mailing address
1417A MOSS ST, LAFAYETTE, LA 70501-3654
(337) 291-2411
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1949221
—
LA
Enumeration date
03/29/2007
Last updated
03/19/2025
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