Provider Demographics
NPI:1295396901
Name:BROWN, KIMBERLY PARKER
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:PARKER
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1590 HIGHWAY 1042
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:LA
Mailing Address - Zip Code:70441-4240
Mailing Address - Country:US
Mailing Address - Phone:225-222-6292
Mailing Address - Fax:
Practice Address - Street 1:1590 HIGHWAY 1042
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:LA
Practice Address - Zip Code:70441-4240
Practice Address - Country:US
Practice Address - Phone:252-222-6292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200636163W00000X, 363LF0000X
MS888721163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
F07182110OtherAANP CERTIFICATION NUMBER