Provider Demographics
NPI:1134958861
Name:LOUQUE, KACIE (NP)
Entity type:Individual
Prefix:
First Name:KACIE
Middle Name:
Last Name:LOUQUE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KACIE
Other - Middle Name:
Other - Last Name:BRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 419
Mailing Address - Street 2:
Mailing Address - City:GRAMERCY
Mailing Address - State:LA
Mailing Address - Zip Code:70052-0419
Mailing Address - Country:US
Mailing Address - Phone:225-869-9200
Mailing Address - Fax:225-869-9241
Practice Address - Street 1:502 RUE DE SANTE STE 301
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-5424
Practice Address - Country:US
Practice Address - Phone:985-652-5475
Practice Address - Fax:985-652-5476
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA236914363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily