Healthcare Provider Details

I. General information

NPI: 1740203041
Provider Name (Legal Business Name): KIMBERLY ANN ABBOTT N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17609 OLD JEFFERSON HWY STE D
PRAIRIEVILLE LA
70769-3980
US

IV. Provider business mailing address

17609 OLD JEFFERSON HWY
PRAIRIEVILLE LA
70769-5242
US

V. Phone/Fax

Practice location:
  • Phone: 225-765-5500
  • Fax: 225-677-9695
Mailing address:
  • Phone: 225-677-9595
  • Fax: 225-677-9695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN089741 AP1480
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: