Provider Demographics
NPI:1386212603
Name:RATLIFF, KELLY CATHERINE (FNP-C)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:CATHERINE
Last Name:RATLIFF
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SCARBOROUGH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE PROVIDENCE
Mailing Address - State:LA
Mailing Address - Zip Code:71254-3018
Mailing Address - Country:US
Mailing Address - Phone:318-559-2814
Mailing Address - Fax:
Practice Address - Street 1:300 SCARBOROUGH ST
Practice Address - Street 2:
Practice Address - City:LAKE PROVIDENCE
Practice Address - State:LA
Practice Address - Zip Code:71254-3018
Practice Address - Country:US
Practice Address - Phone:318-559-2814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA220440363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily