Basic Information
Provider Information
NPI: 1245763192
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KIFER
FirstName: JADEN
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 437 S TELEMACHUS ST
Address2:  
City: NEW ORLEANS
State: LA
PostalCode: 701197041
CountryCode: US
TelephoneNumber: 3187735343
FaxNumber:  
Practice Location
Address1: 4200 HOUMA BLVD FL 6
Address2:  
City: METAIRIE
State: LA
PostalCode: 700062970
CountryCode: US
TelephoneNumber: 5045034331
FaxNumber: 5045034341
Other Information
ProviderEnumerationDate: 04/07/2017
LastUpdateDate: 07/13/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/13/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X313221LAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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