=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811203318
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY AVANT RAO FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2010
-----------------------------------------------------
Last Update Date | 06/28/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 N 3RD ST STE A
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71301-8568
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-625-7299
-----------------------------------------------------
Fax | 318-625-7169
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 211 N 3RD ST STE A
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71301-8568
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 186-257-2993
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP06212
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------