Provider Demographics
NPI:1275601338
Name:LONDEREE, KELLY O (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:O
Last Name:LONDEREE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4405 HIGHWAY 190 EAST SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-4957
Mailing Address - Country:US
Mailing Address - Phone:985-893-8505
Mailing Address - Fax:985-893-0093
Practice Address - Street 1:4405 HIGHWAY 190 EAST SERVICE RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-4957
Practice Address - Country:US
Practice Address - Phone:985-893-8505
Practice Address - Fax:985-893-0093
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09969R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1990311Medicaid