Provider Demographics
NPI:1043988108
Name:EARLEY, KEIFE
Entity Type:Individual
Prefix:
First Name:KEIFE
Middle Name:
Last Name:EARLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 WARREN DR STE B
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-7158
Mailing Address - Country:US
Mailing Address - Phone:318-600-3456
Mailing Address - Fax:318-600-3364
Practice Address - Street 1:903 WARREN DR STE B
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7158
Practice Address - Country:US
Practice Address - Phone:318-600-3456
Practice Address - Fax:318-600-3364
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA223822363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health