1245017094 NPI number — KRISTIN KING MANUEL FNP-C, APRN

Table of content: THEODORE DO (NPI 1407627458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245017094 NPI number — KRISTIN KING MANUEL FNP-C, APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANUEL
Provider First Name:
KRISTIN
Provider Middle Name:
KING
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-C, APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245017094
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1150 WILLOW BROOK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENHAM SPRINGS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70726-2710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-421-6704
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
54016 HIGHWAY 1062
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LORANGER
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70446-3538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-606-9000
Provider Business Practice Location Address Fax Number:
985-878-9568
Provider Enumeration Date:
09/13/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN152976 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: F07230967 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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