Provider Demographics
NPI:1437169539
Name:KUBRICHT, KIMBERLY K (CRNA, NP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:K
Last Name:KUBRICHT
Suffix:
Gender:F
Credentials:CRNA, NP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:KATHERINE
Other - Last Name:KUBRICHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP, CRNA
Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:1001 GAUSE BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2939
Practice Address - Country:US
Practice Address - Phone:985-280-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95007196363L00000X
GARN123975363L00000X, 367500000X
CANA95000640367500000X
LA211667367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP95007196Medicaid
CANA95000640Medicaid
CANP95007196OtherMEDICARE
CANA95000640Medicaid