Provider Demographics
NPI:1285802785
Name:CHILDREN FIRST KIDMED LLC
Entity type:Organization
Organization Name:CHILDREN FIRST KIDMED LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PED NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:RANDOLPH
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:985-419-2250
Mailing Address - Street 1:1828 W THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-2958
Mailing Address - Country:US
Mailing Address - Phone:985-419-2250
Mailing Address - Fax:985-419-2252
Practice Address - Street 1:1828 W THOMAS ST
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-2958
Practice Address - Country:US
Practice Address - Phone:985-419-2250
Practice Address - Fax:985-419-2252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP01814363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty