Provider Demographics
NPI:1043988108
Name:EARLEY, KEIFE
Entity type:Individual
Prefix:
First Name:KEIFE
Middle Name:
Last Name:EARLEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 NORTH PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-7158
Mailing Address - Country:US
Mailing Address - Phone:318-600-3456
Mailing Address - Fax:318-600-3364
Practice Address - Street 1:104 NORTH PARK DRIVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-7158
Practice Address - Country:US
Practice Address - Phone:318-600-3456
Practice Address - Fax:318-374-6828
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71012944A363LP0808X
COC-RXN.0002269-C-NP363LP0808X
WAAP61287233363LP0808X
LA223822363LP0808X
IAG168318363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health