Provider Demographics
NPI:1912262130
Name:GAUDET, KASEY LYNN (RN)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:LYNN
Last Name:GAUDET
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:968 HIGHWAY 20 LOT 1
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-6235
Mailing Address - Country:US
Mailing Address - Phone:985-633-8175
Mailing Address - Fax:
Practice Address - Street 1:2535 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4363
Practice Address - Country:US
Practice Address - Phone:985-447-0921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN101600163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health