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NPI Code Detail

MEDICARE: KIMBERLY PATERNOSTRO BORDELON

MEDICARE: KIMBERLY PATERNOSTRO BORDELON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerAP08813LA

General Provider Information

NPI Number : 1013368794
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY PATERNOSTRO BORDELON
Provider Business Mailing Address
First Line : 28404 LOIRET CT
Second Line :
City : PONCHATOULA
State : LA
Zip : 70454-8102
Country : US
Telephone Number : 985-705-0567
Fax Number :
Provider Business Practice Location Address
First Line : 180 N 5TH ST
Second Line :
City : PONCHATOULA
State : LA
Zip : 70454-2532
Country : US
Telephone Number : 985-370-7546
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2016
Last Update Date : 06/24/2016

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Directions to “ KIMBERLY PATERNOSTRO BORDELON ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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