Individual provider Active NPI

Kelsey Hershey Manguno, MD

  • Pediatrics Physician
  • Covington, LA
National Provider Identifier
1548764327
Registry record updated Dec 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
326106 Issued in LA
Practice address
5025 Keystone Blvd Ste 100
Covington, LA 70433-7526
Phone
(985) 893-3395
Fax
(985) 892-8212
NPI assigned
Mar 19, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 326106 LA Primary

Addresses

Primary practice location

5025 Keystone Blvd Ste 100
Covington, LA 70433-7526

Mailing address

200 Henry Clay Ave
New Orleans, LA 70118-5720
Phone (504) 894-6783

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240823000543 LA Practitioner - Pediatric Medicine 5496294316 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
326106LAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Childrens Hospital Medical Practice Corporation Pediatrics CurrentSince Aug 12, 2024 Accepting new patients

Locations

5025 Keystone Blvd
Covington, LA 70433
Phone (806) 535-3781

5025 Keystone Blvd
Ste 100
Covington, LA 70433
Phone (985) 893-3395

141 Ormond Center Ct
Destrehan, LA 70047
Phone (985) 764-7337

1100 Poydras St
Ste 2500
New Orleans, LA 70163
Phone (504) 527-9953

200 Henry Clay Ave
New Orleans, LA 70118
Phone (504) 412-1860

3020 Gause Blvd E
Slidell, LA 70461
Phone (985) 643-3033

Organizations & group practices 1

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": "1521417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733097600000",
    "number": "1548764327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HENRY CLAY AVE",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701185720",
            "telephone_number": "504-894-6783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5025 KEYSTONE BLVD STE 100",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704337526",
            "telephone_number": "985-893-3395",
            "fax_number": "985-892-8212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGUNO",
        "first_name": "KELSEY",
        "middle_name": "HERSHEY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-19",
        "last_updated": "2024-12-02",
        "certification_date": "2024-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "326106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Covington, LA

Sources for this page

Verify at the official NPI Registry.