Doctor Name: | MRS. KIMBERLY R FANNIN - TRISLER |
NPI Number: | 1043318991 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN |
License Number: | 085994 |
Business Practice Address: | 2106 Loop Rd # C Winnsboro, LA - 712953344 |
Business Phone Number: | 3184354571 |
Business Fax Number: | 3184353842 |
Mailing Address: | 1154 Logan Sewell Dr, VIDALIA |
State: | LA |
Postal Code: | 713733342 |
Phone Number: | 3183368166 |
Fax Number: | 3183368169 |
NPI Enumeration Date: | 09/21/2006 |
NPI Last Update Date: | 03/19/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 085994 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |