Individual
KIMBERLY EXTINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2516 BROADMOOR BLVD STE 1D, MONROE, LA 71201
(318) 807-4746
(318) 812-6034
Mailing address
130 DESIARD ST STE 355, MONROE, LA 71201-7363
(318) 807-7875
(318) 812-6603
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
201192
LA
363LF0000X
Family Nurse Practitioner
Primary
201192
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2486055
—
LA
Enumeration date
05/07/2009
Last updated
09/19/2019
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