KIMBERLY EXTINE (NPI# 1851525687) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851525687 |
| Entity Type | Individual |
| Full Name | KIMBERLY EXTINE |
| Credential | NP |
| Practice Address |
2516 Broadmoor Blvd Ste 1d Monroe LA 71201 |
| Mailing Address |
130 Desiard St Ste 355 Monroe LA 71201-7363 |
| Practice Telephone | 3188074746 |
| Practice Fax Number | 3188126034 |
| Mailing Telephone | 3188077875 |
| Mailing Fax Number | 3188126603 |
| Enumeration Date | 2009-05-07 |
| Last Update Date | 2019-09-19 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | 201192 | LA | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
201192 | LA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 2486055 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 183 Hospital Rd, Suite #b, Winchester, TN 373982470 | 9319681232 | |
| 2516 Broadmoor Blvd Ste 1d, Monroe, LA 71201 | 3188074746 | 3188126034 |
| Street Address |
2516 BROADMOOR BLVD STE 1D |
| City | MONROE |
| State | LA |
| Zip Code | 71201 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568977403 | Affinity Health Group LLC | Orthopaedic Surgery | 2516 Broadmoor Blvd Ste 1d, Monroe, LA 71201-2988 | 2017-12-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043831035 | Tammy Price | Social Worker | 414 Pine Street, Monroe, LA 71201 | 2020-04-30 |
| 1932749116 | Emmanuel Brown Jr. | Case Manager/Care Coordinator | 2808 Evangeline Street, Monroe, LA 71201 | 2020-01-15 |
| 1063050961 | James J Gregory | Social Worker | 4800 S Grand, Monroe, LA 71201 | 2019-12-11 |
| 1285271221 | William Fairley | Non-emergency Medical Transport (VAN) | 1002 N. 7th St., Apt. 4, Monroe, LA 71201 | 2019-12-10 |
| 1619431715 | Guidance Medical Transportation LLC | Non-emergency Medical Transport (VAN) | 1204 Stubbs Ave. Suite B, Monroe, LA 71201 | 2019-01-23 |
| 1184193286 | Marnesha Davis | Assistant Behavior Analyst | 500 N. 21st Street, Monroe, LA 71201 | 2018-11-19 |
| 1912476482 | Gbc Hope | Residential Treatment Facility, Emotionally Disturbed Children | 311 South 1st Street, Monroe, LA 71201 | 2018-11-14 |
| 1124502505 | Orthopaedic Clinic of Monroe | Non-Pharmacy Dispensing Site | 1501 Louisville Ave., Monroe, LA 71201 | 2018-09-20 |
| 1699266643 | Melissa Anne De La O | Audiologist | 2516 Broadmoor Blvd # 1b, Monroe, LA 71201 | 2018-05-25 |
| 1588153738 | Essential Family Medicine, LLC | Nurse Practitioner | 2014 Tower Dr. Ste A, Monroe, LA 71201 | 2018-05-03 |
| Find all providers in zip 71201 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659972347 | Alicia Mitchell | Nurse Practitioner | 1504 Sunset Dr, Monroe, LA 71202-3612 | 2020-11-08 |
| 1114526662 | Angelina Fiszlewicz | Nurse Practitioner | 69 Bayberry Ln, Monroe, OH 45050-2521 | 2020-10-25 |
| 1447857636 | Ashley Norsworthy | Nurse Practitioner | 2600 Tower Dr Ste 216, Monroe, LA 71201-5783 | 2020-10-01 |
| 1417562711 | Tarshia Timothy-jackson | Nurse Practitioner | 2703 Sterlington Rd Apt 76, Monroe, LA 71203-2547 | 2020-09-13 |
| 1891307385 | The Community Np LLC | Nurse Practitioner | 111 Kiowa St, Monroe, LA 71203-8565 | 2020-08-18 |
| 1083223457 | Zydeco Healthcare LLC | Nurse Practitioner | 301 Winkler Way, Monroe, LA 71203-6530 | 2020-07-30 |
| 1194343442 | Courtney Paige Miletello | Nurse Practitioner | 4015 Anna Kate Ln, Monroe, LA 71201-3810 | 2020-07-13 |
| 1942825831 | Kristyn Devun Squyres | Nurse Practitioner | 1401 N 18th St Ste A, Monroe, LA 71201-4972 | 2020-06-16 |
| 1629603337 | Emily Rebecca Buddemeyer | Nurse Practitioner | 814 N Macomb St Ste 1, Monroe, MI 48162-3085 | 2020-03-03 |
| 1760015572 | Jessica Marie Hartle | Nurse Practitioner | 730 N Macomb St Ste 228, Monroe, MI 48162-3087 | 2020-02-20 |
| Find all providers in MONROE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.