Individual provider · Type 1 NPI
Keneitra Brown Roussell, PA-C
Medical Physician Assistant · Reserve, LA
NPI number
1770748097
Active
Practice location
3584 W Airline Hwy
Reserve, LA 70084-5708
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Internal Medicine Physician | 207R00000X | PA200279 (LA) |
| Medical Physician Assistant Primary | 363AM0700X | None listed |
Medical Physician Assistant: Definition to come...
About NPI 1770748097
Keneitra Brown Roussell, PA-C's National Provider Identifier is 1770748097, issued on Jul 25, 2008. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Reserve, LA. The record was last updated on May 21, 2025.