Provider Demographics
NPI:1184045932
Name:GIVENS, KIMBERLY (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:GIVENS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4451 LA HIGHWAY 1 S
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEN
Mailing Address - State:LA
Mailing Address - Zip Code:70767-5907
Mailing Address - Country:US
Mailing Address - Phone:225-749-2273
Mailing Address - Fax:
Practice Address - Street 1:4451 LA HIGHWAY 1 S
Practice Address - Street 2:
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767-5907
Practice Address - Country:US
Practice Address - Phone:225-749-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07312363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily