Organization
KITE GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AYLIE GRAY CREDENTIALING (MANAGER)
(337) 581-5112
Entity
Organization
Contact information
Practice address
913 ALFRED ST, SCOTT, LA 70583-5117
(337) 504-3697
(337) 504-2871
Mailing address
203 LUCE DR, LAFAYETTE, LA 70506-2862
(337) 781-0384
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
03/15/2021
Last updated
03/15/2021
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