Healthcare Provider Details

I. General information

NPI: 1548061039
Provider Name (Legal Business Name): KYMBER BLY BS, OTC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KYMBER FRITZ

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10310 THE GROVE BLVD
BATON ROUGE LA
70836-6455
US

IV. Provider business mailing address

10310 THE GROVE BLVD
BATON ROUGE LA
70836-6455
US

V. Phone/Fax

Practice location:
  • Phone: 225-388-6630
  • Fax:
Mailing address:
  • Phone: 225-388-6630
  • Fax: 225-761-5702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZX2200X
TaxonomyOrthopedic Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: