Provider Demographics
NPI:1922755594
Name:NUNEZ, KALLIE BROOKE (OTR)
Entity Type:Individual
Prefix:
First Name:KALLIE
Middle Name:BROOKE
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KALLIE
Other - Middle Name:BROOKE
Other - Last Name:DUHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:127 W BROAD ST STE 850
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-4394
Mailing Address - Country:US
Mailing Address - Phone:727-773-6420
Mailing Address - Fax:
Practice Address - Street 1:2701 ERNEST ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8406
Practice Address - Country:US
Practice Address - Phone:337-439-0336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA330219208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation