=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124491485
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KS FAMILY MEDICAL CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2015
-----------------------------------------------------
Last Update Date | 11/09/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 550 BROWNSWITCH RD
-----------------------------------------------------
City | SLIDELL
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70458-1104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-445-1414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 550 BROWNSWITCH RD
-----------------------------------------------------
City | SLIDELL
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70458-1104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-445-1414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | BRANDY M KUHN
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 504-432-9733
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | AP06539
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP06539
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------