Moss Street Kid Med LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

MOSS STREET KID MED LLC

Practice address

1417A Moss Street
Lafayette, LA 70501

Phone

(337) 291-2411

Fax

(337) 291-2412

NPI assigned

Mar 29, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Desiree P Richard, RN

Title

Onwer

Phone

(337) 291-2411

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shavondali Harris Cawthorne, FNP-C

  • Family Nurse Practitioner
  • Lafayette, LA
  • NPI 1881204808
  Medicare reassignment NPD
• Michael Ray Melancon, M.D.

  • Pediatrics Physician
  • Lafayette, LA
  • NPI 1992737621
  Medicare reassignment NPD
• Windi Calvert Sullivan, FNP-C

  • Family Nurse Practitioner
  • Lafayette, LA
  • NPI 1780303305
  Medicare reassignment NPD
• Laura Melancon Whipp, FNP-C

  • Family Nurse Practitioner
  • Lafayette, LA
  • NPI 1770405532
  NPD (past)

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742342400000",
    "number": "1336268184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1417A MOSS ST",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705013654",
            "telephone_number": "337-291-2411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1417A MOSS STREET",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "70501",
            "telephone_number": "337-291-2411",
            "fax_number": "337-291-2412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOSS STREET KID MED LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-29",
        "last_updated": "2025-03-19",
        "certification_date": "2025-03-19",
        "status": "A",
        "authorized_official_last_name": "RICHARD",
        "authorized_official_first_name": "DESIREE",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "ONWER",
        "authorized_official_telephone_number": "337-291-2411",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1949221",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Louis Morrow Jr., M.D.
• Tianna M Morton, MD
• Francis J Morvant, D.C.
• Mary Katherine Moses, MS, RD
• Willard Warren Mosier Jr., M.D.
• Moss Street Medical Clinic Inc
• Samuel R, Moss, DDS
• Mother'S Promise
• Motherbirth, LLC
• Desiree Moton

• Clinic/Center in Lafayette, LA
• Providers in Lafayette, LA by specialty
• Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.