Active NPI
Kelly R Davillier, M.D.
- Pediatrics Physician
- New Orleans, LA
National Provider Identifier
1164415998
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MD.024912
- Practice address
- 6823 Saint Charles Ave BLDG 92
New Orleans, LA 70118-5698 - Phone
- (504) 862-3913
- Fax
- (504) 865-5877
- NPI assigned
- Aug 26, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 060168 | GA | |
| Pediatrics Physician | 208000000X | MD.024912 | LA | Primary |
Addresses
Primary practice location
6823 Saint Charles Ave BLDG 92
New Orleans, LA 70118-5698
Mailing address
6823 Saint Charles Ave BLDG 92
New Orleans, LA 70118-5698
Phone (504) 862-3913
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1420565 | Medicaid | LA | |
| 1899964650A | Medicaid | GA | |
| MD.024912 | Other | LA | LOUISIANA STATE BOARD MEDICAL EXAMINERS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD.024912 | LA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wellstar Health System, Inc. | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125014400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731888000000",
"number": "1164415998",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6823 SAINT CHARLES AVE BLDG 92",
"city": "NEW ORLEANS",
"state": "LA",
"postal_code": "701185698",
"telephone_number": "504-862-3913",
"fax_number": "504-865-5877"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6823 SAINT CHARLES AVE BLDG 92",
"city": "NEW ORLEANS",
"state": "LA",
"postal_code": "701185698",
"telephone_number": "504-862-3913",
"fax_number": "504-865-5877"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVILLIER",
"first_name": "KELLY",
"middle_name": "R",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-08-26",
"last_updated": "2024-11-18",
"certification_date": "2024-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "GA",
"license": "060168",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "LA",
"license": "MD.024912",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1420565",
"state": "LA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1899964650A",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LOUISIANA STATE BOARD MEDICAL EXAMINERS",
"identifier": "MD.024912",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in New Orleans, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.