Provider Demographics
NPI:1578897914
Name:BALDRIDGE, KATHY HEBERT (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:HEBERT
Last Name:BALDRIDGE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5191
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71361-5191
Mailing Address - Country:US
Mailing Address - Phone:318-641-2244
Mailing Address - Fax:318-641-2297
Practice Address - Street 1:100 PINECREST DR
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4276
Practice Address - Country:US
Practice Address - Phone:318-641-2244
Practice Address - Fax:318-641-2297
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05848363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily