Kellie Roy Bertrand, CFNP
Individual provider Active NPI Family Nurse Practitioner · Simmesport, LA
NPI 1225014665 · NPPES record last updated May 1, 2013
Key facts
- NPI
- 1225014665
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- RN096429 AP04315 (LA)
- Practice address
- 118 JJJ LN
Simmesport, LA 71369-2180 - Phone
- (318) 941-5286
- Fax
- (318) 941-5284
- NPI assigned
- Dec 19, 2005
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN096429 AP04315 | LA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| KD Health & Wellness Center LLC | Past |
Accepting new patients | |
| Our Lady of the Lake Hospital Inc | Past | Accepting new patients | |
| Maringouin Medical Center, LLC | Past | Accepting new patients | |
| Stanocola Employees Medical and Hospital Association, Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | RN096429 AP04315 | LA | Yes |
Addresses
Primary practice location
118 JJJ LN
Simmesport, LA 71369-2180
Mailing address
8415 Goodwood Blvd
Suite 105
Baton Rouge, LA 70806-7851
Phone (225) 765-5727
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174882 | Medicaid | LA |
Other names
- Kellie Chantelle Roy
Other providers in Simmesport, LA
- Bayou Chateau Nursing Center, Inc
- Country Clinic, LLC
- Finecia Renee Draper
- Firmin Family Health Clinics LLC
- Crystal G Firmin
- Krista Johnson
All providers in Simmesport, LA · Family Nurse Practitioner in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 1, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.