Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP09728 | LA |
NPI | 1003316423 |
---|---|
Provider Name | Mrs. Kameryn Kline Fevella |
First Address | Zachary, LA 70791-3618 |
Second Address | Saint Francisville, LA 70775-4510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2018 |
Last Update Date | 13/02/2018 |