Provider Demographics
NPI:1447665427
Name:KILPATRICK, NOREEN
Entity type:Individual
Prefix:
First Name:NOREEN
Middle Name:
Last Name:KILPATRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4447 WARE AVE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:LA
Mailing Address - Zip Code:70121-1326
Mailing Address - Country:US
Mailing Address - Phone:504-756-8430
Mailing Address - Fax:504-736-9731
Practice Address - Street 1:4447 WARE AVE
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:LA
Practice Address - Zip Code:70121-1326
Practice Address - Country:US
Practice Address - Phone:504-756-8430
Practice Address - Fax:504-736-9731
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-27
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ11021174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAZ11021OtherLICENSURE