Provider Demographics
NPI:1699831552
Name:WELCH-SPENCER, KEIDRA ALBERTINE (MD)
Entity type:Individual
Prefix:DR
First Name:KEIDRA
Middle Name:ALBERTINE
Last Name:WELCH-SPENCER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KEIDRA
Other - Middle Name:ALBERTINE
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:520 N LEWIS ST STE 204
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-2094
Mailing Address - Country:US
Mailing Address - Phone:337-364-7700
Mailing Address - Fax:337-364-5777
Practice Address - Street 1:520 N LEWIS ST STE 204
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563
Practice Address - Country:US
Practice Address - Phone:337-364-7700
Practice Address - Fax:337-364-5777
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200590207Q00000X
LAMD.200590207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1012246Medicaid
LA468818YJTEOtherMEDICARE
LA468818YJAPOtherMEDICARE PIN-SWLA CENTER FOR HS (GROUP)