Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 206498 | LA |
NPI | 1003476144 |
---|---|
Provider Name | Miss Kandice Nicole Hunter |
First Address | Monroe, LA 71202-3922 |
Second Address | Monroe, LA 71202-6400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2019 |
Last Update Date | 19/10/2020 |