Provider Demographics
NPI:1699121947
Name:HEKMATDOOST, KATHLEEN GIBEAU (APRN, NNP)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:GIBEAU
Last Name:HEKMATDOOST
Suffix:
Gender:F
Credentials:APRN, NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 JUDGE TANNER BLVD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7500
Mailing Address - Country:US
Mailing Address - Phone:985-867-4360
Mailing Address - Fax:
Practice Address - Street 1:95 JUDGE TANNER BLVD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7500
Practice Address - Country:US
Practice Address - Phone:985-867-4360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01855363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care