Provider Demographics
NPI:1609426279
Name:O'NEAL, KENNETH
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:O'NEAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7809 AIRLINE DR STE 305A
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-6448
Mailing Address - Country:US
Mailing Address - Phone:504-267-1234
Mailing Address - Fax:
Practice Address - Street 1:7809 AIRLINE DR
Practice Address - Street 2:STE 305A
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70003-6448
Practice Address - Country:US
Practice Address - Phone:504-267-1234
Practice Address - Fax:504-324-2094
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator