Doctor Name: | NIKITA PEARL |
NPI Number: | 1093107310 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | AP07896 |
Business Practice Address: | 721 Avenue G Kentwood, LA - 704442601 |
Business Phone Number: | 8884147247 |
Business Fax Number: | |
Mailing Address: | Po Box 770, ZACHARY |
State: | LA |
Postal Code: | 707910770 |
Phone Number: | 8884147247 |
Fax Number: | 2256581282 |
NPI Enumeration Date: | 02/24/2015 |
NPI Last Update Date: | 02/24/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | AP07896 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |