Provider Demographics
NPI:1356892194
Name:DERMATOLOGY CENTER OF ACADIANA LLC
Entity type:Organization
Organization Name:DERMATOLOGY CENTER OF ACADIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:R
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-235-6886
Mailing Address - Street 1:1245 S COLLEGE RD
Mailing Address - Street 2:BLDG 5
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2917
Mailing Address - Country:US
Mailing Address - Phone:337-235-6886
Mailing Address - Fax:337-235-6892
Practice Address - Street 1:1245 S COLLEGE RD
Practice Address - Street 2:BLDG 5
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2917
Practice Address - Country:US
Practice Address - Phone:337-235-6886
Practice Address - Fax:337-235-6892
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KRISTY R KENNEDY, MD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.204714207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty