Healthcare Provider Details

I. General information

NPI: 1205395498
Provider Name (Legal Business Name): KIMBERLY RENA PURVIS RSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 LAPALI HINA
TROUT LA
71371-4115
US

IV. Provider business mailing address

906 YEARBY HILL LOOP
JENA LA
71342
US

V. Phone/Fax

Practice location:
  • Phone: 318-992-2763
  • Fax: 318-217-2312
Mailing address:
  • Phone: 318-419-2434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number8164
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: