Provider Demographics
NPI:1891543526
Name:GORSHA, KATHRYN KREA
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:KREA
Last Name:GORSHA
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:PO BOX 450
Mailing Address - Street 2:
Mailing Address - City:MANSURA
Mailing Address - State:LA
Mailing Address - Zip Code:71350-0450
Mailing Address - Country:US
Mailing Address - Phone:318-964-2683
Mailing Address - Fax:
Practice Address - Street 1:2104 CLECO ST
Practice Address - Street 2:
Practice Address - City:MANSURA
Practice Address - State:LA
Practice Address - Zip Code:71350-4451
Practice Address - Country:US
Practice Address - Phone:318-964-2679
Practice Address - Fax:318-964-2683
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1544761Medicaid