Individual
MR. KYLE MANCUSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
4353 HWY 1 S, PORT ALLEN, LA 70767-5826
(225) 749-2645
(225) 749-2645
Mailing address
4353 HWY 1 S, PORT ALLEN, LA 70767-5826
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
201694
LA
Other
Enumeration date
08/08/2023
Last updated
08/10/2023
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