Basic Information
| Provider Information | |||||||||
| NPI: | 1093797169 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIGHT | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | RRT, MSN, DNP, FNPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 122108 | ||||||||
| Address2: | DEPT 2108 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753122108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3374942919 | ||||||||
| FaxNumber: | 3374943069 | ||||||||
| Practice Location | |||||||||
| Address1: | 1717 OAK PARK BLVD FL 3 | ||||||||
| Address2: | |||||||||
| City: | LAKE CHARLES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706018990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3374808066 | ||||||||
| FaxNumber: | 3374808109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2005 | ||||||||
| LastUpdateDate: | 06/13/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LC1500X | APO 4828 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Community Health |
ID Information
| ID | Type | State | Issuer | Description | APO 4828 | 01 | LA | STATE LICENSE | OTHER | 111356 | 05 | LA | MEDICAID | RN 081903 | 01 | LA | STATE LICENSE | OTHER |