Healthcare Provider Details

I. General information

NPI: 1811930951
Provider Name (Legal Business Name): KIMBERLY SIMONEAUX CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 11/16/2024
Certification Date: 11/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15695 PROFESSIONAL PLZ
HAMMOND LA
70403-1411
US

IV. Provider business mailing address

PO BOX 2668 BUSINESS CTR - INS CREDENTIALING
HAMMOND LA
70404-2668
US

V. Phone/Fax

Practice location:
  • Phone: 985-542-2599
  • Fax: 985-345-0880
Mailing address:
  • Phone: 985-230-1682
  • Fax: 985-230-6652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP04904
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: