Extine, Kimberly

Extine, Kimberly is an individual health care provider with primary practice located at 2516 Broadmoor Blvd Ste 1D , Monroe LA 71201. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Extine, Kimberly can be contacted via phone (318) 807-4746.

Contact Information

Primary practice address
2516 Broadmoor Blvd Ste 1D Monroe LA 71201
Phone: (318) 807-4746
Fax: (318) 812-6034
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 201192 Louisiana
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 201192 Louisiana

Profile Details

NPI number 1851525687
LBN Legal business name Extine, Kimberly
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date May 7th, 2009
Last updated Sep 19th, 2019 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1851525687 NPPES
Louisiana MEDICAID 2486055

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