Basic Information
| Provider Information | |||||||||
| NPI: | 1417315193 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROLAND | ||||||||
| FirstName: | KIMBERLY | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 123543 DEPT 3543 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753123543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8556868430 | ||||||||
| FaxNumber: | 9042658181 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 CYPRESS ST | ||||||||
| Address2: | |||||||||
| City: | SULPHUR | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706635053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3375277034 | ||||||||
| FaxNumber: | 9042658181 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2016 | ||||||||
| LastUpdateDate: | 03/08/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP08670 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.