Provider Demographics
NPI:1437920063
Name:WILLOUGHBY, KIMBERLY APRIL
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:APRIL
Last Name:WILLOUGHBY
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 1:144 DERUSSO ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70364-2421
Mailing Address - Country:US
Mailing Address - Phone:985-746-2236
Mailing Address - Fax:
Practice Address - Street 1:144 DERUSSO ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70364-2421
Practice Address - Country:US
Practice Address - Phone:985-746-2236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA30002501164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse