Provider Demographics
NPI:1568276343
Name:THOMAS, KRISTINA CHRISTOPHE (PMHNP)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:CHRISTOPHE
Last Name:THOMAS
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-4337
Mailing Address - Country:US
Mailing Address - Phone:337-852-9285
Mailing Address - Fax:
Practice Address - Street 1:626 BROAD ST # B
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-4337
Practice Address - Country:US
Practice Address - Phone:337-852-9285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA239729363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health