Provider Demographics
NPI:1497796742
Name:NORWOOD, KIMBERLY JUNICE (CRNA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JUNICE
Last Name:NORWOOD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16491 MAJESTIC OAK DR
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-4838
Mailing Address - Country:US
Mailing Address - Phone:225-247-6386
Mailing Address - Fax:225-332-6117
Practice Address - Street 1:5001 STATESMAN DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-2414
Practice Address - Country:US
Practice Address - Phone:972-501-3237
Practice Address - Fax:972-983-0253
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04782367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1582794Medicaid
LA4H921B064Medicare ID - Type Unspecified