Provider Demographics
NPI:1518106707
Name:ROBEAU, KYMBERLY G (NP)
Entity Type:Individual
Prefix:
First Name:KYMBERLY
Middle Name:G
Last Name:ROBEAU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KYMBERLY
Other - Middle Name:
Other - Last Name:GALLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1408 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:COTTONPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71327-3514
Mailing Address - Country:US
Mailing Address - Phone:318-876-2800
Mailing Address - Fax:318-876-2803
Practice Address - Street 1:1408 FRONT ST
Practice Address - Street 2:
Practice Address - City:COTTONPORT
Practice Address - State:LA
Practice Address - Zip Code:71327-3514
Practice Address - Country:US
Practice Address - Phone:318-876-2800
Practice Address - Fax:318-876-2803
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN094754163W00000X
LAAP04351363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1800821Medicaid
LA1800821Medicaid