Individual
KEIDRA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, RN
Contact information
Practice address
2615 ENTERPRISE BLVD STE B, LAKE CHARLES, LA 70601-7686
(337) 802-1757
Mailing address
5408 WATERSIDE DR, LAKE CHARLES, LA 70607-1004
(337) 802-1757
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN129991
LA
Other
Enumeration date
06/16/2026
Last updated
06/16/2026
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