Provider Demographics
NPI:1750745964
Name:HARGIS, KAILA SMITH (NP)
Entity type:Individual
Prefix:MRS
First Name:KAILA
Middle Name:SMITH
Last Name:HARGIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:KAILA
Other - Middle Name:D
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 3087
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-3087
Mailing Address - Country:US
Mailing Address - Phone:985-230-3668
Mailing Address - Fax:985-370-7409
Practice Address - Street 1:1900 S MORRISON BLVD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5742
Practice Address - Country:US
Practice Address - Phone:985-230-5726
Practice Address - Fax:985-230-7861
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08719363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2422332Medicaid