Provider Demographics
NPI:1952064966
Name:KITE CLINIC LLC
Entity Type:Organization
Organization Name:KITE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:337-273-0352
Mailing Address - Street 1:203 LUCE DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-2862
Mailing Address - Country:US
Mailing Address - Phone:337-781-0384
Mailing Address - Fax:
Practice Address - Street 1:312 GUILBEAU RD STE 3C
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-6953
Practice Address - Country:US
Practice Address - Phone:337-273-0352
Practice Address - Fax:318-460-0339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-17
Last Update Date:2021-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty