Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | TAP003243 | LA |
NPI | 1013328533 |
---|---|
Provider Name | Ms. Kitty Kervin |
First Address | Monroe, LA 71201-7319 |
Second Address | West Monroe, LA 71291-4453 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2014 |
Last Update Date | 15/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2385658 | (05) | LA |