Provider Demographics
NPI:1083195440
Name:MORRIS LANDRY, KENYA M
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:M
Last Name:MORRIS LANDRY
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 1:1202 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-2307
Mailing Address - Country:US
Mailing Address - Phone:504-319-7402
Mailing Address - Fax:
Practice Address - Street 1:1202 MONROE ST
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-2307
Practice Address - Country:US
Practice Address - Phone:504-309-6798
Practice Address - Fax:504-407-2115
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator