Provider Demographics
NPI:1023804127
Name:MARICLE, KAITLYN
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:MARICLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 HIGHWAY 462
Mailing Address - Street 2:
Mailing Address - City:PITKIN
Mailing Address - State:LA
Mailing Address - Zip Code:70656-2613
Mailing Address - Country:US
Mailing Address - Phone:318-290-8203
Mailing Address - Fax:
Practice Address - Street 1:119 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:LA
Practice Address - Zip Code:71463-3034
Practice Address - Country:US
Practice Address - Phone:318-335-0260
Practice Address - Fax:318-335-3356
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-16
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA241323363LF0000X
LARN160492163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse