Healthcare Provider Details

I. General information

NPI: 1215426432
Provider Name (Legal Business Name): KIMBERLY VILLEMARETTE HULL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5025 SHED RD
BOSSIER CITY LA
71111-5434
US

IV. Provider business mailing address

1959 WILD IRIS
BOSSIER CITY LA
71112-4681
US

V. Phone/Fax

Practice location:
  • Phone: 318-795-4741
  • Fax: 318-795-4742
Mailing address:
  • Phone: 318-286-3786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP09850
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: