Healthcare Provider Details

I. General information

NPI: 1447759337
Provider Name (Legal Business Name): KIMBERLY BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13755 RIVER ROAD
LULING LA
70070
US

IV. Provider business mailing address

10833 RIVER ROAD #51
AMA LA
70031-5002
US

V. Phone/Fax

Practice location:
  • Phone: 504-408-0757
  • Fax: 504-408-0757
Mailing address:
  • Phone: 504-563-0021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number1160080314
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: