Individual
KELLY M DERISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1900 GRAVIER ST, NEW ORLEANS, LA 70112-2262
(504) 568-4106
Mailing address
423 OAK MANOR DR, NEW IBERIA, LA 70563-2243
(337) 380-0161
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
205692
LA
367500000X
Certified Registered Nurse Anesthetist
Primary
985451
NY
Other
Enumeration date
01/06/2025
Last updated
01/15/2026
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