Provider Demographics
NPI:1326610981
Name:BOATNER, KAIA
Entity Type:Individual
Prefix:
First Name:KAIA
Middle Name:
Last Name:BOATNER
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 1:6294 PAYNE RD
Mailing Address - Street 2:
Mailing Address - City:ETHEL
Mailing Address - State:LA
Mailing Address - Zip Code:70730-3306
Mailing Address - Country:US
Mailing Address - Phone:225-244-0961
Mailing Address - Fax:
Practice Address - Street 1:3550 GOVERNMENT ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-5718
Practice Address - Country:US
Practice Address - Phone:225-343-8878
Practice Address - Fax:225-334-9075
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.023884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist