Provider Demographics
NPI:1811203318
Name:RAO, KIMBERLY AVANT (FNP)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:AVANT
Last Name:RAO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:FITZPATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:211 N 3RD ST STE A
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-8568
Mailing Address - Country:US
Mailing Address - Phone:186-257-2993
Mailing Address - Fax:
Practice Address - Street 1:211 N 3RD ST STE A
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8568
Practice Address - Country:US
Practice Address - Phone:318-625-7299
Practice Address - Fax:318-625-7169
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06212363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2195565Medicaid
3C229DE36Medicare PIN