Dermatology Center of Acadiana LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MD.204714 Issued in LA

Legal business name

DERMATOLOGY CENTER OF ACADIANA LLC

Practice address

1245 S College Rd
BLDG 5
Lafayette, LA 70503-2917

Phone

(337) 235-6886

Fax

(337) 235-6892

NPI assigned

Oct 17, 2016

Organization subpart

Yes

Parent organization

KRISTY R KENNEDY, MD LLCAs reported in NPPES

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

Authorized official

Name

Dr. Kristy R Kennedy, MDNPI 1609091875

Title

President

Phone

(337) 235-6886

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Kristy R Kennedy MD LLC

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Kristy R. Kennedy MD, LLC

  • Medical Specialty Clinic/Center
  • Lafayette, LA
  • NPI 1801142906
  NPPES parent name

Practitioners 3

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

• Kristy Roper Kennedy, M.D.

  • Dermatology Physician
  • Lafayette, LA
  • NPI 1609091875
  Medicare reassignment Care Compare group NPD Authorized official
• Thomas L Briscoe, PA-C

  • Medical Physician Assistant
  • Lafayette, LA
  • NPI 1992796189
  Medicare reassignment Care Compare group
• Donna Jeanne Vial, PA

  • Physician Assistant
  • Lafayette, LA
  • NPI 1306878186
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1476662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476662400000",
    "number": "1356892194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1245 S COLLEGE RD",
            "address_2": "BLDG 5",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705032917",
            "telephone_number": "337-235-6886",
            "fax_number": "337-235-6892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1245 S COLLEGE RD",
            "address_2": "BLDG 5",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705032917",
            "telephone_number": "337-235-6886",
            "fax_number": "337-235-6892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY CENTER OF ACADIANA LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KRISTY R KENNEDY, MD LLC",
        "enumeration_date": "2016-10-17",
        "last_updated": "2016-10-17",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "KRISTY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "337-235-6886",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "LA",
            "license": "MD.204714",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carl S. Deranger, CRNA
• Bobbi Eugenia Deras, NP
• Derek Baumbouree, MD, Apmc
• Claire Kaufman Derge, OT
• Dermatology and Allergy Clinic of South Louisiana LTD Apmc
• Brandi Armentor Derouen
• Charli Rhea Derouen, MS, LAC, CCS
• Germaine Derouen, LCSW
• Lauren B Derouen, MS, RD, LDN
• Macie Derouen

• Dermatology Physician in Lafayette, LA
• Providers in Lafayette, LA by specialty
• Dermatology Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.