Provider Demographics
NPI:1467813931
Name:BOOKER, KISSLEY (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KISSLEY
Middle Name:
Last Name:BOOKER
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20051 OLD SCENIC HWY
Mailing Address - Street 2:APT 1805
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-7369
Mailing Address - Country:US
Mailing Address - Phone:225-306-5737
Mailing Address - Fax:
Practice Address - Street 1:11764 HAYMARKET AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-6009
Practice Address - Country:US
Practice Address - Phone:225-256-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08729363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA540405ZSC1OtherMEDICARE
LA2433792Medicaid