Provider Demographics
NPI:1740203041
Name:ABBOTT, KIMBERLY ANN (NP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17609 OLD JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-5242
Mailing Address - Country:US
Mailing Address - Phone:225-677-9595
Mailing Address - Fax:225-677-9695
Practice Address - Street 1:17609 OLD JEFFERSON HWY STE D
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3980
Practice Address - Country:US
Practice Address - Phone:225-765-5500
Practice Address - Fax:225-677-9695
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN089741 AP1480363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1583294Medicaid
LA4H913Medicare PIN