Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Kyle Mancuso, FNP-C

Individual provider Family Nurse Practitioner · NPI 1861175820

Mr. Kyle Mancuso, FNP-C is a Nurse Practitioner in Port Allen, Louisiana. Qualified in 2023, 3 years ago. Practices with Our Lady of the Lake Physician Group LLC, a 635-clinician group and accepts Medicare assignment. Licensed in Louisiana.

Years since qualifying
3
Licensed in
LA
In the registry since
2023
What do these letters mean?
FNP-C — Family Nurse Practitioner, Certified
A family nurse practitioner certified by the AANP.

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Practice location Address checks out

4353 Hwy 1 S
Port Allen, LA 70767-5826
Phone: (225) 749-2645
Fax: (225) 749-2645
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 201694 (LA)

Record details

NPI number1861175820
Entity typeIndividual (Type 1)
GenderMale
Credentials FNP-C
Sole proprietorNo
NPI enumeratedAugust 8, 2023
Last updated in NPPESAugust 10, 2023
Certification dateAugust 10, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Our Lady Of The Lake Physician Group Llc — 635 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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