Provider Demographics
NPI:1366957664
Name:MOLINE, KIMBERLY D (RN)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:D
Last Name:MOLINE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 DREUX AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70126-3502
Mailing Address - Country:US
Mailing Address - Phone:504-343-8679
Mailing Address - Fax:
Practice Address - Street 1:4230 DREUX AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70126-3502
Practice Address - Country:US
Practice Address - Phone:504-343-8679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN117804163WX0003X, 163WM0102X, 163WP2201X, 163WX0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk