Provider Demographics
NPI:1538593538
Name:THOMPSON, KEYTHA LUBIRTA (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KEYTHA
Middle Name:LUBIRTA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MRS
Other - First Name:KEYTHA
Other - Middle Name:BROWN
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:5439 AIRLINE HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70805-1712
Mailing Address - Country:US
Mailing Address - Phone:225-582-2513
Mailing Address - Fax:225-757-4093
Practice Address - Street 1:5439 AIRLINE HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-1712
Practice Address - Country:US
Practice Address - Phone:225-358-2251
Practice Address - Fax:225-358-2282
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07409363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2346091Medicaid
LA316996YJ6VMedicare UPIN