Provider Demographics
NPI:1154629558
Name:KAOUGH, CARESSA ELZIA
Entity type:Individual
Prefix:
First Name:CARESSA
Middle Name:ELZIA
Last Name:KAOUGH
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 1:5455 HEBERTS PASS
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-7705
Mailing Address - Country:US
Mailing Address - Phone:337-513-8036
Mailing Address - Fax:
Practice Address - Street 1:5455 HEBERTS PASS
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-7705
Practice Address - Country:US
Practice Address - Phone:337-513-8036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA236037363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health