Provider Demographics
NPI:1578953139
Name:SPIKES BICKHAM, KELA (DNP)
Entity Type:Individual
Prefix:
First Name:KELA
Middle Name:
Last Name:SPIKES BICKHAM
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70380 HIGHWAY 21 STE 2
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-8128
Mailing Address - Country:US
Mailing Address - Phone:985-893-0693
Mailing Address - Fax:337-643-8407
Practice Address - Street 1:112 INNWOOD DR STE H
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-9134
Practice Address - Country:US
Practice Address - Phone:985-893-0693
Practice Address - Fax:337-643-8407
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08162363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAAP08162OtherLICENSE NUMBER
LA2402056Medicaid
LA409543Medicare PIN