Provider Demographics
NPI:1124485776
Name:LATO, KADY MILLICAN
Entity type:Individual
Prefix:
First Name:KADY
Middle Name:MILLICAN
Last Name:LATO
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 1:17581 OLD JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3930
Mailing Address - Country:US
Mailing Address - Phone:225-755-9779
Mailing Address - Fax:225-452-0006
Practice Address - Street 1:17581 OLD JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3930
Practice Address - Country:US
Practice Address - Phone:225-755-9779
Practice Address - Fax:225-452-0006
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08683363LF0000X
KY130480163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse