Individual
KIMBERLY PATERNOSTRO BORDELON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
180 N 5TH ST, PONCHATOULA, LA 70454-2532
(985) 370-7546
Mailing address
28404 LOIRET CT, PONCHATOULA, LA 70454-8102
(985) 705-0567
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP08813
LA
Other
Enumeration date
06/24/2016
Last updated
06/24/2016
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