Provider Demographics
NPI:1669112850
Name:BREAUX, KIZZY
Entity type:Individual
Prefix:
First Name:KIZZY
Middle Name:
Last Name:BREAUX
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 1:203 LARIMER ST APT D
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-7910
Mailing Address - Country:US
Mailing Address - Phone:337-278-7470
Mailing Address - Fax:833-411-2118
Practice Address - Street 1:203 LARIMER ST APT D
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-7910
Practice Address - Country:US
Practice Address - Phone:337-278-7470
Practice Address - Fax:833-411-2118
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246RP1900X
LA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy