Provider Demographics
NPI:1538943675
Name:DEAN, KATHLEEN VICTORIA (NP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:VICTORIA
Last Name:DEAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:VICTORIA
Other - Last Name:HIMEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24739 KELLER ST
Mailing Address - Street 2:
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70764-5948
Mailing Address - Country:US
Mailing Address - Phone:225-776-1383
Mailing Address - Fax:
Practice Address - Street 1:59215 RIVER WEST DR
Practice Address - Street 2:
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-6552
Practice Address - Country:US
Practice Address - Phone:225-776-1383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA230599363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily