Provider Demographics
NPI:1912976614
Name:TOUPS, KELLY L (APRN-BC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:TOUPS
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 SAND BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4504
Mailing Address - Country:US
Mailing Address - Phone:318-401-6709
Mailing Address - Fax:
Practice Address - Street 1:152 SAND BEACH BLVD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4504
Practice Address - Country:US
Practice Address - Phone:318-401-6709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04292363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2490397Medicaid
LAP99572Medicare UPIN