Provider Demographics
NPI:1912612466
Name:DELAHOUSSAYE, KRISTIN (FNP-BC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:DELAHOUSSAYE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 HORSESHOE DR
Mailing Address - Street 2:
Mailing Address - City:MERIGOLD
Mailing Address - State:MS
Mailing Address - Zip Code:38759-9658
Mailing Address - Country:US
Mailing Address - Phone:662-299-9259
Mailing Address - Fax:
Practice Address - Street 1:1400 E UNION ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-3246
Practice Address - Country:US
Practice Address - Phone:662-725-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905760363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily