Provider Demographics
NPI:1124858543
Name:KN ENTERPRISE, LLC
Entity type:Organization
Organization Name:KN ENTERPRISE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:J
Authorized Official - Last Name:RAVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-939-4904
Mailing Address - Street 1:1801 MANHATTAN BLVD
Mailing Address - Street 2:SUITE J226
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-7300
Mailing Address - Country:US
Mailing Address - Phone:504-715-6658
Mailing Address - Fax:
Practice Address - Street 1:9163 COMAR DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:WALKER
Practice Address - State:LA
Practice Address - Zip Code:70785-7019
Practice Address - Country:US
Practice Address - Phone:504-715-6658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2503472Medicaid