MEDICARE: KIMBERLEY HARRIS SMITH FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP05502	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134314198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLEY HARRIS SMITH FNP-BC

Provider Business Mailing Address
First Line	:	2255 S BURNSIDE AVE
Second Line	:
City	:	GONZALES
State	:	LA
Zip	:	70737-4642
Country	:	US
Telephone Number	:	800-256-3947
Fax Number	:	225-250-1026

Provider Business Practice Location Address
First Line	:	2255 S BURNSIDE AVE
Second Line	:
City	:	GONZALES
State	:	LA
Zip	:	70737-4642
Country	:	US
Telephone Number	:	800-256-3947
Fax Number	:	225-250-1026

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2007
Last Update Date	:	05/05/2021

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