Provider Demographics
NPI:1396126074
Name:KRISTINA LANDRY INC
Entity type:Organization
Organization Name:KRISTINA LANDRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:G
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:337-506-2294
Mailing Address - Street 1:1257 MAYEAUXVILLE RD
Mailing Address - Street 2:
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-8409
Mailing Address - Country:US
Mailing Address - Phone:337-831-1704
Mailing Address - Fax:318-443-9116
Practice Address - Street 1:1257 MAYEAUXVILLE RD
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-8409
Practice Address - Country:US
Practice Address - Phone:337-506-2294
Practice Address - Fax:929-259-5972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04414363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty