Provider Demographics
NPI:1942851654
Name:MCMANUS, KELLI (APRN-CPNP-PC)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:MCMANUS
Suffix:
Gender:F
Credentials:APRN-CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4630 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6949
Mailing Address - Country:US
Mailing Address - Phone:337-456-6892
Mailing Address - Fax:
Practice Address - Street 1:1268 SOUTHAMPTON DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3036
Practice Address - Country:US
Practice Address - Phone:318-449-4886
Practice Address - Fax:318-449-4877
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP208698363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics