Provider Demographics
NPI:1992589626
Name:USSIN, KANNEYA KAY (PEER SUPPORT)
Entity type:Individual
Prefix:MS
First Name:KANNEYA
Middle Name:KAY
Last Name:USSIN
Suffix:
Gender:F
Credentials:PEER SUPPORT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 N HULLEN ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-5117
Mailing Address - Country:US
Mailing Address - Phone:504-875-7555
Mailing Address - Fax:
Practice Address - Street 1:3308 TULANE AVE STE 405
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-7167
Practice Address - Country:US
Practice Address - Phone:504-342-4222
Practice Address - Fax:504-342-4225
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOBHPSS1045171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator