Individual
DR. KELLY MARIE FUQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
920 1ST AVE, SULPHUR, LA 70663-3425
(337) 527-7034
Mailing address
3659 W WEATHERBY DR, SULPHUR, LA 70665-8719
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
200962
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1072907
—
LA
Enumeration date
04/27/2008
Last updated
10/13/2012
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