Provider Demographics
NPI:1063761898
Name:HANNAMAN, KRISTEN HEBERT (PA)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:HEBERT
Last Name:HANNAMAN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:10319 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-2730
Mailing Address - Country:US
Mailing Address - Phone:225-214-9352
Mailing Address - Fax:225-214-9349
Practice Address - Street 1:1905 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5203
Practice Address - Country:US
Practice Address - Phone:337-990-8000
Practice Address - Fax:337-990-8010
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2013-08-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA782363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant