Provider Demographics
NPI:1073344222
Name:PREJEAN, KEVIN JAMES
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:JAMES
Last Name:PREJEAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 E SAINT PETER ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-3752
Mailing Address - Country:US
Mailing Address - Phone:337-367-5858
Mailing Address - Fax:337-359-9083
Practice Address - Street 1:439 E SAINT PETER ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-3752
Practice Address - Country:US
Practice Address - Phone:337-367-5858
Practice Address - Fax:337-359-9083
Is Sole Proprietor?:No
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA22037855143747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant