=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881087682
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAMP MANAGEMENT, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2015
-----------------------------------------------------
Last Update Date | 03/18/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 240 CANDY CRAIG DR
-----------------------------------------------------
City | CALHOUN
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71225-8661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-366-3039
-----------------------------------------------------
Fax | 318-325-6202
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 463
-----------------------------------------------------
City | CALHOUN
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71225-0463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-366-3039
-----------------------------------------------------
Fax | 318-325-6202
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. ELIZABETH M PHILLIPS
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 318-366-3039
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP05273
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------