Healthcare Provider Details

I. General information

NPI: 1124491485
Provider Name (Legal Business Name): KS FAMILY MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 BROWNSWITCH RD
SLIDELL LA
70458-1104
US

IV. Provider business mailing address

550 BROWNSWITCH RD
SLIDELL LA
70458-1104
US

V. Phone/Fax

Practice location:
  • Phone: 985-445-1414
  • Fax:
Mailing address:
  • Phone: 985-445-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP06539
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP06539
License Number StateLA

VIII. Authorized Official

Name: BRANDY M KUHN
Title or Position: CEO
Credential: APRN
Phone: 504-432-9733