Provider Demographics
NPI:1487644712
Name:DROST, KELLI MAY (APRN, BC, FNP)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:MAY
Last Name:DROST
Suffix:
Gender:F
Credentials:APRN, BC, FNP
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:MEREDITH MAY
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:108 HARVEST OAKS CIRCLE
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71292-0000
Mailing Address - Country:US
Mailing Address - Phone:318-537-0323
Mailing Address - Fax:
Practice Address - Street 1:427 S VINE ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-4513
Practice Address - Country:US
Practice Address - Phone:318-556-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA075341163W00000X
LA03722363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA020318OtherPRESCRIPTIVE AUTHORITY
LAP00149461OtherRAILROAD M/CARE
LA1181790Medicaid
LA4B795Medicare ID - Type Unspecified
P33492Medicare UPIN