Provider Demographics
NPI:1912475773
Name:NASTASI, KELLY J (FNP-BC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:NASTASI
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:985-730-6970
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:1416 GOBBLER HEAD DR
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-6091
Practice Address - Country:US
Practice Address - Phone:985-730-6970
Practice Address - Fax:985-735-8883
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP10100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily