Provider Demographics
NPI:1619216066
Name:O'ROURKE, KERSHUNDALA W (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KERSHUNDALA
Middle Name:W
Last Name:O'ROURKE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:SHAWN
Other - Middle Name:WRIGHT
Other - Last Name:O'ROURKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:170 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70802-7655
Mailing Address - Country:US
Mailing Address - Phone:225-389-6697
Mailing Address - Fax:225-389-6702
Practice Address - Street 1:170 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-7655
Practice Address - Country:US
Practice Address - Phone:225-389-6697
Practice Address - Fax:225-389-6702
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA250914164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse