Provider Demographics
NPI:1326788506
Name:CALAIS-KELLY, KENDRA (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:
Last Name:CALAIS-KELLY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 ISLAND NEST CV
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-5856
Mailing Address - Country:US
Mailing Address - Phone:504-905-4359
Mailing Address - Fax:
Practice Address - Street 1:420 ALBERTSON PKWY
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518-4968
Practice Address - Country:US
Practice Address - Phone:337-237-6444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA224679363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health