Active NPI
Keona Monique Isaac
- Prosthetic/Orthotic Supplier
- Tallulah, LA
National Provider Identifier
1609647726
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetic/Orthotic Supplier
- License
- 1334671108
- Practice address
- 120 Kimbrough Blvd
Tallulah, LA 71282-4307 - Phone
- (318) 341-6785
- NPI assigned
- Jan 9, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthetic/Orthotic Supplier | 335E00000X | 1334671108 | LA | Primary |
Addresses
Primary practice location
120 Kimbrough Blvd
Tallulah, LA 71282-4307
Mailing address
120 Kimbrough Blvd
Tallulah, LA 71282-4307
Phone (318) 341-6785
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1334671108 | LA | MD | Prosthetic/Orthotic Supplier |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1704758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704758400000",
"number": "1609647726",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 KIMBROUGH BLVD",
"city": "TALLULAH",
"state": "LA",
"postal_code": "712824307",
"telephone_number": "318-341-6785"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 KIMBROUGH BLVD",
"city": "TALLULAH",
"state": "LA",
"postal_code": "712824307",
"telephone_number": "318-341-6785"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ISAAC",
"first_name": "KEONA",
"middle_name": "MONIQUE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-01-09",
"last_updated": "2024-01-09",
"certification_date": "2024-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "335E00000X",
"taxonomy_group": "",
"desc": "Prosthetic/Orthotic Supplier",
"state": "LA",
"license": "1334671108",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tallulah, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.