Provider Demographics
NPI:1568788479
Name:HABETZ, KENNETH RICHMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:RICHMOND
Last Name:HABETZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4704 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6908
Mailing Address - Country:US
Mailing Address - Phone:337-470-5920
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:4704 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6908
Practice Address - Country:US
Practice Address - Phone:337-470-5920
Practice Address - Fax:855-431-6867
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-16
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA3016792084N0402X
ARE92392084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology