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General NPI Number Information
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NPI Number | 1659884385
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Entity Type | Individual
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Provider Name | KATHRYN OLIVIA ZIMMERMAN PA
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Gender | Female
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Dates
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Enumeration Date | 11/16/2017
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Last Update Date | 12/27/2017
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Provider Practice Location Address
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Address Line | 1717 OAK PARK BLVD FL 3
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City | LAKE CHARLES
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State | LA
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Zip | 70601-8990
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Country | US
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Telephone | 337-494-4900
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Fax | 337-494-4936
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Provider Business Mailing Address
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Address Line | P O BOX 122165 DEPT 2165
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City | DALLAS
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State | TX
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Zip | 75312-2165
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Country | US
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Telephone | 337-494-2948
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Fax | 337-494-2928
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 307370
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License Number State | LA
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