Individual
KENDALL DUET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
602 N ACADIA RD, THIBODAUX, LA 70301-4823
(985) 447-5500
Mailing address
PO BOX 1393, GALLIANO, LA 70354-1393
(504) 228-1642
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
304560
LA
Other
Enumeration date
01/31/2017
Last updated
11/28/2023
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