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NPI Code Detail

MEDICARE: KIRBY DWAYNE HUMBLES NP

MEDICARE: KIRBY DWAYNE HUMBLES NP
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
1363LA2200XAdult Health Nurse PractitionerAP04446LA

Other Identifiers

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

General Provider Information

NPI Number : 1770580060
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIRBY DWAYNE HUMBLES NP
Provider Business Mailing Address
First Line : 8333 GOODWOOD BLVD # NA
Second Line :
City : BATON ROUGE
State : LA
Zip : 70806-7744
Country : US
Telephone Number : 225-272-0106
Fax Number : 225-275-4558
Provider Business Practice Location Address
First Line : 8333 GOODWOOD BLVD # NA
Second Line :
City : BATON ROUGE
State : LA
Zip : 70806-7744
Country : US
Telephone Number : 225-272-0106
Fax Number : 225-275-4558
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2005
Last Update Date : 10/23/2018

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