Provider Demographics
NPI:1851663306
Name:MANINA, KIMBERLY RENEE (FNP-C)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:RENEE
Last Name:MANINA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:54033 HIGHWAY 1062
Mailing Address - Street 2:SUITE B
Mailing Address - City:LORANGER
Mailing Address - State:LA
Mailing Address - Zip Code:70446-3538
Mailing Address - Country:US
Mailing Address - Phone:985-606-2273
Mailing Address - Fax:985-606-2268
Practice Address - Street 1:54033 HIGHWAY 1062
Practice Address - Street 2:SUITE B
Practice Address - City:LORANGER
Practice Address - State:LA
Practice Address - Zip Code:70446-3538
Practice Address - Country:US
Practice Address - Phone:985-606-2273
Practice Address - Fax:985-606-2268
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06729363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2194089Medicaid
LA249831YJXFMedicare PIN