Individual
MR. KENNETH LANE GARY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
N.P.
Contact information
Practice address
701 CYPRESS ST, SULPHUR, LA 70663-5053
(337) 527-4270
(337) 527-4288
Mailing address
4521 OAK RIDGE DR, SULPHUR, LA 70665-9379
(337) 526-2777
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN094922-AP04928
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1019631
—
LA
Enumeration date
02/19/2007
Last updated
03/09/2015
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