Healthcare Provider Details

I. General information

NPI: 1417332891
Provider Name (Legal Business Name): KIMBERLY J SILLS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MOSLEY RD
DRY PRONG LA
71423-4033
US

IV. Provider business mailing address

500 MOSLEY RD
DRY PRONG LA
71423-4033
US

V. Phone/Fax

Practice location:
  • Phone: 318-359-8034
  • Fax:
Mailing address:
  • Phone: 318-359-8034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP08460
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: