Kimberly Paternostro Bordelon

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP08813 Issued in LA

Practice address

180 N 5TH St
Ponchatoula, LA 70454-2532

Phone

(985) 370-7546

NPI assigned

Jun 24, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Integrated Dermatology of Ponchatoula LLCGroup PAC ID 6103126974, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Integrated Dermatology of Ponchatoula, LLC

  • Dermatology Physician
  • Ponchatoula, LA
  • NPI 1508234600
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1466726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466726400000",
    "number": "1013368794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28404 LOIRET CT",
            "city": "PONCHATOULA",
            "state": "LA",
            "postal_code": "704548102",
            "telephone_number": "985-705-0567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 N 5TH ST",
            "city": "PONCHATOULA",
            "state": "LA",
            "postal_code": "704542532",
            "telephone_number": "985-370-7546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORDELON",
        "first_name": "KIMBERLY",
        "middle_name": "PATERNOSTRO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-24",
        "last_updated": "2016-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "AP08813",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas J Bergeron Jr.
• Lynn Jones Bikoi, NP
• Blitz Transportation Servies
• Sindy Bollich
• Koi Booker
• Heather Bourlet
• Julie C. Breaux, LPC
• Jessica Marie Brignac, PHARMD
• Keyadda Brim
• April K Brown

• Family Nurse Practitioner in Ponchatoula, LA
• Providers in Ponchatoula, LA by specialty
• Family Nurse Practitioner in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.