Provider Demographics
NPI:1477188738
Name:MANUEL, KENISHA HAMPTON (FNP-C)
Entity Type:Individual
Prefix:
First Name:KENISHA
Middle Name:HAMPTON
Last Name:MANUEL
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 1:11 SAINT LOUPE DR
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-6492
Mailing Address - Country:US
Mailing Address - Phone:504-957-2194
Mailing Address - Fax:
Practice Address - Street 1:4550 NORTH BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4013
Practice Address - Country:US
Practice Address - Phone:225-926-3343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-06
Last Update Date:2020-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA208448363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily