NPIMap

Individual provider Active NPI

Kacey Rae Lopez, PA

  • Physician Assistant
  • Lafayette, LA
National Provider Identifier
1164892204
Registry record updated Jun 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
300080 Issued in LA
Practice address
4801 Ambassador Caffery Parkway
Lafayette, LA 70508-3983
Phone
(337) 470-2605
Fax
(337) 470-4595
NPI assigned
Oct 1, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 300080 LA
Physician Assistant 363A00000X 300080 LA Primary

Addresses

Primary practice location

4801 Ambassador Caffery Parkway
Lafayette, LA 70508-3983

Mailing address

5959 S Sherwood Forest Blvd
Baton Rouge, LA 70816-6038
Phone (225) 526-0636

Other practice location 1

3311 Prescott Rd Ste 202
Alexandria, LA 71301-3983
Phone (318) 442-0106

Other names 1

  • Kacey Rae Buckner Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160303002291 LA Practitioner - Physician Assistant 8921304734 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Louisiana State University School of Medicine in Shreveport, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lourdes Physician Group LLCGroup PAC ID 7214177757, 157 clinicians

Practice addresses (Care Compare)

4801 Ambassador Caffery Pkwy
Lafayette, LA 70508-6917
Phone (337) 470-2990

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
300080LAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Calcasieu Urgent Care LLC CurrentSince May 18, 2021 Accepting new patients
Calcasieu Urgent Care, LLC CurrentSince May 18, 2021 Accepting new patients
Lourdes After Hours LLC CurrentSince Aug 31, 2022 Accepting new patients
Louisiana Em-1 Medical Services, PC Physician Assistant Past Accepting new patients

Locations

3824 NE Evangeline Thruway
Carencro, LA 70520
Phone (337) 565-2675

2640 Country Club Rd
Ste 400
Lake Charles, LA 70605
Phone (337) 426-0919

Interoperability endpoints

  • Direct secure messaging: kbuckner405758@christushealth.direct-ci.net
  • Direct secure messaging: klopez1483131@direct.ochsner.org

Organizations & group practices 9

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1443657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687737600000",
    "number": "1164892204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5959 S SHERWOOD FOREST BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708166038",
            "telephone_number": "225-526-0636",
            "fax_number": "225-765-9616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 AMBASSADOR CAFFERY PARKWAY",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705083983",
            "telephone_number": "337-470-2605",
            "fax_number": "337-470-4595"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3311 Prescott Rd Ste 202",
            "address_purpose": "LOCATION",
            "city": "Alexandria",
            "state": "LA",
            "postal_code": "713013983",
            "country_code": "US",
            "telephone_number": "318-442-0106",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "KACEY",
        "middle_name": "RAE",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-01",
        "last_updated": "2023-06-26",
        "certification_date": "2023-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "LA",
            "license": "300080",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "LA",
            "license": "300080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KACEY",
            "last_name": "BUCKNER",
            "middle_name": "RAE",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lafayette, LA

Sources for this page

Verify at the official NPI Registry.