Provider Demographics
NPI:1811670623
Name:TEASETT, KALYN (TRS)
Entity type:Individual
Prefix:
First Name:KALYN
Middle Name:
Last Name:TEASETT
Suffix:
Gender:F
Credentials:TRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9853 WESTERLY AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70814-4223
Mailing Address - Country:US
Mailing Address - Phone:225-572-0075
Mailing Address - Fax:
Practice Address - Street 1:11607 SOUTHFORK AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-5220
Practice Address - Country:US
Practice Address - Phone:504-641-4297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2024-06-05
Deactivation Date:2023-09-25
Deactivation Code:
Reactivation Date:2023-10-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist