MEDICARE: MRS. KIMBERLY VILLEMARETTE HULL FNP

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
1	363LF0000X	Family Nurse Practitioner	AP09850	LA

General Provider Information

NPI Number	:	1215426432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY VILLEMARETTE HULL FNP

Provider Business Mailing Address
First Line	:	1959 WILD IRIS
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71112-4681
Country	:	US
Telephone Number	:	318-286-3786
Fax Number	:

Provider Business Practice Location Address
First Line	:	5025 SHED RD
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-5434
Country	:	US
Telephone Number	:	318-795-4741
Fax Number	:	318-795-4742

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2018
Last Update Date	:	12/04/2024

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