Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | APO 4828 | LA |
NPI | 1093797169 |
---|---|
Provider Name | John Joseph Kight |
First Address | Dallas, TX 75312-2108 |
Second Address | Lake Charles, LA 70601-8990 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2005 |
Last Update Date | 13/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
111356 | (05) | LA |
APO 4828 | STATE LICENSE (01) | LA |
RN 081903 | STATE LICENSE (01) | LA |