Provider Demographics
NPI:1407688427
Name:FAVORITE, KIARA SHAREL
Entity type:Individual
Prefix:MRS
First Name:KIARA
Middle Name:SHAREL
Last Name:FAVORITE
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 1:7425 CORPORATE BLVD STE 820
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1193
Mailing Address - Country:US
Mailing Address - Phone:225-778-8664
Mailing Address - Fax:
Practice Address - Street 1:7425 CORPORATE BLVD STE 820
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1193
Practice Address - Country:US
Practice Address - Phone:225-778-8664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA159156163W00000X
LA239757363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse