Individual
KIM EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7223 MISSISSIPPI AVENUE, FORT POLK, LA 71459
(337) 531-2121
Mailing address
7223 MISSISSIPPI AVENUE, FORT POLK, LA 71459
(337) 531-2121
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
1613
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1613
DO NOT KNOW
LA
Enumeration date
06/27/2016
Last updated
06/27/2016
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