Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | AP10033 | LA |
NPI | 1003301375 |
---|---|
Provider Name | Mrs. Kristen King |
First Address | Hammond, LA 70403-1436 |
Second Address | Hammond, LA 70403-1436 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2018 |
Last Update Date | 28/06/2018 |