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Individual

MR. KENNETH ALLAN EBERSOLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
APRN,FNP

Contact information

Practice address
277 N HIGHWAY 171, SUITE 10, LAKE CHARLES, LA 70611-5374
(337) 217-7762
(337) 855-5310
Mailing address
501 DOCTOR MICHAEL DEBAKEY DR, LAKE CHARLES, LA 70601-5724
(337) 312-8258
(337) 312-6708

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP03160
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1558761
LA
Enumeration date
01/30/2006
Last updated
03/20/2017
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