Provider Demographics
NPI:1447703251
Name:KAY, LORI
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:KAY
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 1:2704 HODGES ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-7366
Mailing Address - Country:US
Mailing Address - Phone:712-646-3385
Mailing Address - Fax:337-340-9401
Practice Address - Street 1:2704 HODGES ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7366
Practice Address - Country:US
Practice Address - Phone:712-646-3385
Practice Address - Fax:337-340-9401
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08978363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2432541Medicaid