Provider Demographics
NPI:1396996351
Name:BOSTICK-FIELD, KIMBERLY (NP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BOSTICK-FIELD
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 1:9372 HWY 165 SOUTH
Mailing Address - Street 2:
Mailing Address - City:WOODWORTH
Mailing Address - State:LA
Mailing Address - Zip Code:71485
Mailing Address - Country:US
Mailing Address - Phone:318-484-9588
Mailing Address - Fax:318-484-9590
Practice Address - Street 1:9372 HWY 165 SOUTH
Practice Address - Street 2:
Practice Address - City:WOODWORTH
Practice Address - State:LA
Practice Address - Zip Code:71485
Practice Address - Country:US
Practice Address - Phone:318-484-9588
Practice Address - Fax:318-484-9590
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA73172-5487363LF0000X
LARN073172-AP05487363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily