Kenneth Allan Ebersole, APRN,FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP03160 Issued in LA

Practice address

277 N Highway 171
Suite 10
Lake Charles, LA 70611-5374

Phone

(337) 217-7762

Fax

(337) 855-5310

NPI assigned

Jan 30, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Emergency Medicine Specialist, Apmc

  • Emergency Medicine Physician
  • Lake Charles, LA
  • NPI 1750460234
  NPD (past)
• Imperial Health LLP

  • Family Medicine Physician
  • Lake Charles, LA
  • NPI 1326396375
  NPD (past)
• Minor Medical Clinic LLC

  • Health Service Clinic/Center
  • Lake Charles, LA
  • NPI 1720008675
  NPD (past)

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

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489968000000",
    "number": "1699746487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 DOCTOR MICHAEL DEBAKEY DR",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706015724",
            "telephone_number": "337-312-8258",
            "fax_number": "337-312-6708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "277 N HIGHWAY 171",
            "address_2": "SUITE 10",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706115374",
            "telephone_number": "337-217-7762",
            "fax_number": "337-855-5310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBERSOLE",
        "first_name": "KENNETH",
        "middle_name": "ALLAN",
        "name_prefix": "Mr.",
        "credential": "APRN,FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-30",
        "last_updated": "2017-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "AP03160",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1558761",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sherrie Tilley Eakin, MSN, FNP-C
• Paula Ducote Eapen, MD
• Steven C. East, O.D.
• Hannah Eastman Fawcett, O.D.
• Eb'S Orthotics & Prosthetics LLC
• Laney Doucett Ebersole, PHARMD
• Madison Miller Ebersole, MS, RD, LDN
• Jeffrey Ebin, MD
• Sarah Eccles, SLP
• Wayne Rusty Eckel, PT

• Family Nurse Practitioner in Lake Charles, LA
• Providers in Lake Charles, LA by specialty
• Family Nurse Practitioner in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.