Provider Demographics
NPI:1992888036
Name:CHILDREN FIRST KIDMED
Entity type:Organization
Organization Name:CHILDREN FIRST KIDMED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADULT NURSE PRACTITIONER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:225-567-7150
Mailing Address - Street 1:19115 FLORIDA BLVD
Mailing Address - Street 2:STE. A
Mailing Address - City:ALBANY
Mailing Address - State:LA
Mailing Address - Zip Code:70711
Mailing Address - Country:US
Mailing Address - Phone:225-567-7150
Mailing Address - Fax:225-567-7120
Practice Address - Street 1:19115 FLORIDA BLVD STE A
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:LA
Practice Address - Zip Code:70711-3701
Practice Address - Country:US
Practice Address - Phone:225-567-7150
Practice Address - Fax:225-567-7120
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN FIRST KIDMED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-23
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04271363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty