Provider Demographics
NPI:1124276621
Name:DEVILLE, KATHLEEN ELISABETH (FNP-C)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ELISABETH
Last Name:DEVILLE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 WOOD SPGS
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-7705
Mailing Address - Country:US
Mailing Address - Phone:318-294-4565
Mailing Address - Fax:
Practice Address - Street 1:208 MORRIS DR
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-3053
Practice Address - Country:US
Practice Address - Phone:318-377-8260
Practice Address - Fax:318-377-9053
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2023-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05591363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily