Individual
BRENDA J KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
108 GLENDALE ST, PINEVILLE, LA 71360-5646
(318) 613-3087
Mailing address
108 GLENDALE ST, PINEVILLE, LA 71360-5646
(318) 613-3087
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
LA
Other
Enumeration date
07/24/2024
Last updated
08/12/2024
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