Individual provider Active NPI

La Shonda Nicole Kennerson

  • Professional Counselor
  • Lake Charles, LA
National Provider Identifier
1538697644
Registry record updated Nov 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
8597 Issued in LA
Practice address
4105 Kirkman St
Lake Charles, LA 70607-4603
Phone
(337) 475-3100
Fax
(337) 475-3105
NPI assigned
Jun 2, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 8597 LA Primary

Addresses

Primary practice location

4105 Kirkman St
Lake Charles, LA 70607-4603

Mailing address

4105 Kirkman St
Lake Charles, LA 70607-4603
Phone (337) 475-3100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250310002169 LA Practitioner - Mental Health Counselor 7214458017 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Imperial Calcasieu Human Services Authority Current Accepting new patients
Imperial Calcasieu Human Services Authority CurrentSince Feb 26, 2025 Accepting new patients
Imperial Calcasieu Human Services Authority CurrentSince Feb 26, 2025 Accepting new patients
Imperial Calcasieu Human Services Authority Past Accepting new patients

Locations

106 W Port St
Deridder, LA 70634
Phone (337) 462-1461

437 N Market St
Jennings, LA 70546
Phone (337) 246-7325

4105 Kirkman St
Lake Charles, LA 70607
Phone (337) 475-3100

145 Hospital Dr
Oakdale, LA 71463
Phone (337) 639-3001

2651 E Napoleon St
Sulphur, LA 70663
Phone (337) 625-6750

Organizations & group practices 4

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": "1496361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762732800000",
    "number": "1538697644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4105 KIRKMAN ST",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706074603",
            "telephone_number": "337-475-3100",
            "fax_number": "337-475-3105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4105 KIRKMAN ST",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706074603",
            "telephone_number": "337-475-3100",
            "fax_number": "337-475-3105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNERSON",
        "first_name": "LA SHONDA",
        "middle_name": "NICOLE",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-02",
        "last_updated": "2025-11-10",
        "certification_date": "2025-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "LA",
            "license": "8597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.