Provider Demographics
NPI:1538697644
Name:KENNERSON, LA SHONDA NICOLE
Entity Type:Individual
Prefix:MS
First Name:LA SHONDA
Middle Name:NICOLE
Last Name:KENNERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 COMMON ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5255
Mailing Address - Country:US
Mailing Address - Phone:337-437-4014
Mailing Address - Fax:337-437-8283
Practice Address - Street 1:1333 COMMON ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5255
Practice Address - Country:US
Practice Address - Phone:337-437-4014
Practice Address - Fax:337-437-4014
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator