Provider Demographics
NPI:1891983144
Name:LORANT, KIMBERLY NOLAND (PA-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:NOLAND
Last Name:LORANT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:JAYE
Other - Last Name:NOLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1455 E BERT KOUN LOOP
Mailing Address - Street 2:SUITE #210
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5634
Mailing Address - Country:US
Mailing Address - Phone:318-798-4623
Mailing Address - Fax:318-798-4668
Practice Address - Street 1:1455 E BERT KOUN LOOP
Practice Address - Street 2:SUITE #210
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5634
Practice Address - Country:US
Practice Address - Phone:318-798-4623
Practice Address - Fax:318-798-4668
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200151363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1023485Medicaid
LA5F600P979Medicare PIN
LA57720PG50Medicare PIN
LA321984YJS0Medicare PIN