Provider Demographics
NPI:1720117773
Name:PREJEAN, AIRNAGENE KATHERINE (MS)
Entity Type:Individual
Prefix:MRS
First Name:AIRNAGENE
Middle Name:KATHERINE
Last Name:PREJEAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:PREJEAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:121 MEADOW GLEN DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-5331
Mailing Address - Country:US
Mailing Address - Phone:337-856-9258
Mailing Address - Fax:
Practice Address - Street 1:302 DULLES DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-3008
Practice Address - Country:US
Practice Address - Phone:337-262-1226
Practice Address - Fax:337-262-4183
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator