Provider Demographics
NPI:1245618651
Name:BILLEAUDEAUX, STEPHEN KIRK (RN)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:KIRK
Last Name:BILLEAUDEAUX
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19520 PATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:WELSH
Mailing Address - State:LA
Mailing Address - Zip Code:70591-6516
Mailing Address - Country:US
Mailing Address - Phone:337-540-0638
Mailing Address - Fax:
Practice Address - Street 1:106 W PORT ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-4040
Practice Address - Country:US
Practice Address - Phone:337-462-1461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN117188163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse