Healthcare Provider Details

I. General information

NPI: 1992888036
Provider Name (Legal Business Name): CHILDREN FIRST KIDMED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 10/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19115 FLORIDA BLVD STE A
ALBANY LA
70711-3701
US

IV. Provider business mailing address

19115 FLORIDA BLVD STE. A
ALBANY LA
70711
US

V. Phone/Fax

Practice location:
  • Phone: 225-567-7150
  • Fax: 225-567-7120
Mailing address:
  • Phone: 225-567-7150
  • Fax: 225-567-7120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP04271
License Number StateLA

VIII. Authorized Official

Name: NICOLE A BAILEY
Title or Position: ADULT NURSE PRACTITIONER/MANAGER
Credential: APRN
Phone: 225-567-7150