Provider Demographics
NPI:1174815054
Name:HARDING, KIMBERLY P (PA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:P
Last Name:HARDING
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:P
Other - Last Name:HOLLIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 919229
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-9229
Mailing Address - Country:US
Mailing Address - Phone:337-289-8944
Mailing Address - Fax:337-571-0030
Practice Address - Street 1:4212 W CONGRESS ST STE 3100
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-6771
Practice Address - Country:US
Practice Address - Phone:337-703-3201
Practice Address - Fax:337-703-3202
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9105975363A00000X
FLPA9105975363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant