Provider Demographics
NPI:1447140025
Name:WEBER, KELLY B
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:B
Last Name:WEBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 W CAUSEWAY APPROACH
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3045
Mailing Address - Country:US
Mailing Address - Phone:985-326-8501
Mailing Address - Fax:985-326-8503
Practice Address - Street 1:1423 W CAUSEWAY APPROACH
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3045
Practice Address - Country:US
Practice Address - Phone:985-326-8501
Practice Address - Fax:985-326-8503
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist