Provider Demographics
NPI:1366099939
Name:YOUNG, KRYSTAL (LPN)
Entity type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 BERTRAND DR STE D5
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-9104
Mailing Address - Country:US
Mailing Address - Phone:337-446-1223
Mailing Address - Fax:337-269-5964
Practice Address - Street 1:1304 BERTRAND DR STE D5
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-9104
Practice Address - Country:US
Practice Address - Phone:337-446-1223
Practice Address - Fax:337-269-5964
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
LA20180184164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA20180184OtherLPN
0000000OtherPPO