Basic Information
| Provider Information | |||||||||
| NPI: | 1164531778 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENOIT | ||||||||
| FirstName: | KATHY | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FAMILY NURSE PRACTIT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 805 HEART D FARM RD | ||||||||
| Address2: | |||||||||
| City: | YOUNGSVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70592 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372616356 | ||||||||
| FaxNumber: | 3372616474 | ||||||||
| Practice Location | |||||||||
| Address1: | 2390 WEST CONGRESS | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70596 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372616000 | ||||||||
| FaxNumber: | 3372616474 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 04/17/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RN076923 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1155128 | 05 | LA | MEDICAID |