Organization
MEDICAL WIGS BY KIMBERLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY NICOLE BRYANT (CRANIAL PROSTHESIS SPECIALIST-OWNER)
(318) 453-3693
Entity
Organization
Contact information
Practice address
1303 LINE AVE STE 300, SHREVEPORT, LA 71101-4628
(318) 453-3693
Mailing address
1303 LINE AVE STE 300, SHREVEPORT, LA 71101-4628
(318) 453-3693
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
02/25/2021
Last updated
04/04/2025
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