Provider Demographics
NPI:1386176527
Name:TKJ HEALTHCARE LLC
Entity type:Organization
Organization Name:TKJ HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEMPTON-JEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:504-451-7066
Mailing Address - Street 1:585 E CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-2737
Mailing Address - Country:US
Mailing Address - Phone:504-451-7066
Mailing Address - Fax:
Practice Address - Street 1:719 AVENUE G
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:LA
Practice Address - Zip Code:70444-2601
Practice Address - Country:US
Practice Address - Phone:504-451-7066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07453363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty