Provider Demographics
NPI:1447749304
Name:RACHAL, DVM, KELLY E (DVM)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:E
Last Name:RACHAL, DVM
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 MOUNCE RD
Mailing Address - Street 2:
Mailing Address - City:GRAND CANE
Mailing Address - State:LA
Mailing Address - Zip Code:71032-5715
Mailing Address - Country:US
Mailing Address - Phone:504-402-7779
Mailing Address - Fax:
Practice Address - Street 1:4445 YOUREE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-3618
Practice Address - Country:US
Practice Address - Phone:318-865-5595
Practice Address - Fax:318-868-3289
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2755174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty