Provider Demographics
NPI:1427029438
Name:LAW, KIMBERLY DAWN (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:DAWN
Last Name:LAW
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2920 KNIGHT ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-2412
Mailing Address - Country:US
Mailing Address - Phone:318-861-7340
Mailing Address - Fax:318-861-7390
Practice Address - Street 1:2920 KNIGHT ST
Practice Address - Street 2:SUITE 110
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2412
Practice Address - Country:US
Practice Address - Phone:318-861-7340
Practice Address - Fax:318-861-7390
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-28
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.1999872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1063100Medicaid
LA1063100Medicaid
LAI51240Medicare UPIN