Provider Demographics
NPI:1407121304
Name:ACCARDO, KATHRYN MICHELE (FNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MICHELE
Last Name:ACCARDO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:MONK
Other - Last Name:GARNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 3370
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70434-3370
Mailing Address - Country:US
Mailing Address - Phone:985-400-5988
Mailing Address - Fax:985-256-5687
Practice Address - Street 1:1970 N HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5364
Practice Address - Country:US
Practice Address - Phone:985-867-8585
Practice Address - Fax:985-867-3644
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06772363LF0000X, 363LF0000X
LARN095988363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2187350Medicaid
MS09357098Medicaid
LA3D0487061Medicare PIN