1699839944 NPI number — LOUISIANA ASSOCIATION FOR THE BLIND, INC.

Table of content: ROSA MOON KELLER PH.D., R.D. (NPI 1720704810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699839944 NPI number — LOUISIANA ASSOCIATION FOR THE BLIND, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOUISIANA ASSOCIATION FOR THE BLIND, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699839944
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1750 CLAIBORNE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71103-4119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-635-6471
Provider Business Mailing Address Fax Number:
318-635-8901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1714 CLAIBORNE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71103-4119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-698-2300
Provider Business Practice Location Address Fax Number:
888-990-0751
Provider Enumeration Date:
12/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MUSLOW - HICKS
Authorized Official First Name:
AUDRA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
INTERIM CEO
Authorized Official Telephone Number:
318-698-2300

Provider Taxonomy Codes

  • Taxonomy code: 225XL0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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