Provider Demographics
NPI:1063532612
Name:OGLESBY, KAYLA GEORGETTE
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:GEORGETTE
Last Name:OGLESBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-5346
Mailing Address - Country:US
Mailing Address - Phone:337-546-6500
Mailing Address - Fax:337-457-4750
Practice Address - Street 1:400 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-5346
Practice Address - Country:US
Practice Address - Phone:337-546-6500
Practice Address - Fax:337-457-4750
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1566659Medicaid