Provider Demographics
NPI:1003316423
Name:FEVELLA, KAMERYN KLINE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KAMERYN
Middle Name:KLINE
Last Name:FEVELLA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:KAMERYN
Other - Middle Name:MICHELLE
Other - Last Name:KLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4508 39TH ST
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-3618
Mailing Address - Country:US
Mailing Address - Phone:225-719-0093
Mailing Address - Fax:
Practice Address - Street 1:5326 OAK ST
Practice Address - Street 2:
Practice Address - City:SAINT FRANCISVILLE
Practice Address - State:LA
Practice Address - Zip Code:70775-4510
Practice Address - Country:US
Practice Address - Phone:225-635-5848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09728363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily