Individual
KIMBERLY ANN BONVILLIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2750 GAUSE BLVD E, SLIDELL, LA 70461-4149
(985) 639-3777
(985) 639-3725
Mailing address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121-2429
(504) 842-4000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
343191
LA
363A00000X
Physician Assistant
—
—
Other
Enumeration date
03/06/2024
Last updated
09/04/2024
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