Provider Demographics
NPI:1891309001
Name:WALES, KATHY JEAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:JEAN
Last Name:WALES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1130
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:LA
Mailing Address - Zip Code:70754-1130
Mailing Address - Country:US
Mailing Address - Phone:225-686-7044
Mailing Address - Fax:225-686-3052
Practice Address - Street 1:13964 GUY ST
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:LA
Practice Address - Zip Code:70785-8035
Practice Address - Country:US
Practice Address - Phone:225-939-7750
Practice Address - Fax:225-686-3082
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA053141163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse