Provider Demographics
NPI:1871303586
Name:STRAWDER KELLY, TIA
Entity type:Individual
Prefix:MS
First Name:TIA
Middle Name:
Last Name:STRAWDER KELLY
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 1:110 E MARTIAL AVE APT 2121
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6969
Mailing Address - Country:US
Mailing Address - Phone:337-212-6599
Mailing Address - Fax:
Practice Address - Street 1:100 E ANGELLE ST STE N4
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520-5900
Practice Address - Country:US
Practice Address - Phone:337-212-6599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty