Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP06258 | LA |
NPI | 1003116682 |
---|---|
Provider Name | Kimberly J Bonts |
First Address | Shreveport, LA 71101-3910 |
Second Address | Shreveport, LA 71118-3130 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2010 |
Last Update Date | 06/07/2021 |