Provider Demographics
NPI:1124546478
Name:VAN MOL, KIRSTEN ELIZABETH (FNP-C)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:ELIZABETH
Last Name:VAN MOL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:ELIZABETH
Other - Last Name:MUDD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5419 JACKSON ST STE B
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2322
Mailing Address - Country:US
Mailing Address - Phone:318-787-2708
Mailing Address - Fax:318-787-2716
Practice Address - Street 1:5419 JACKSON ST STE B
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2322
Practice Address - Country:US
Practice Address - Phone:318-787-2708
Practice Address - Fax:318-787-2716
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09428363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily