Provider Demographics
NPI:1962139626
Name:CALCOTE BORDELON, KRISTEN MARIE (FNP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARIE
Last Name:CALCOTE BORDELON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 ELMWOOD PKWY
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-2537
Mailing Address - Country:US
Mailing Address - Phone:504-715-9237
Mailing Address - Fax:
Practice Address - Street 1:4409 UTICA ST STE 100
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-6579
Practice Address - Country:US
Practice Address - Phone:504-457-3687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-03
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA226939363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily