Provider Demographics
NPI:1295940559
Name:FINAN, KELLY RENEE (MD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:RENEE
Last Name:FINAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7777 HENNESSY BLVD STE 507
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4366
Mailing Address - Country:US
Mailing Address - Phone:225-767-1156
Mailing Address - Fax:225-767-5980
Practice Address - Street 1:7777 HENNESSY BLVD STE 507
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4366
Practice Address - Country:US
Practice Address - Phone:225-767-1156
Practice Address - Fax:225-767-5980
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL25779208600000X
LA203031208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1885100Medicaid
LA1885100Medicaid