Provider Demographics
NPI:1275902694
Name:DANIELS, KYLIE ISIDORE
Entity Type:Individual
Prefix:MRS
First Name:KYLIE
Middle Name:ISIDORE
Last Name:DANIELS
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 1:1401 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2426
Mailing Address - Country:US
Mailing Address - Phone:504-842-4747
Mailing Address - Fax:504-842-7577
Practice Address - Street 1:1401 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-2426
Practice Address - Country:US
Practice Address - Phone:504-842-4747
Practice Address - Fax:504-842-7577
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08516363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01803203Medicaid
LA2403338Medicaid
LA444664YH3UMedicare PIN