Provider Demographics
NPI:1003125790
Name:KRISTI PREJEANT LLC
Entity Type:Organization
Organization Name:KRISTI PREJEANT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:PREJEANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-384-3433
Mailing Address - Street 1:1302 LAKEWOOD DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-1800
Mailing Address - Country:US
Mailing Address - Phone:985-384-3433
Mailing Address - Fax:985-384-3453
Practice Address - Street 1:1302 LAKEWOOD DR
Practice Address - Street 2:SUITE 202
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1800
Practice Address - Country:US
Practice Address - Phone:985-384-3433
Practice Address - Fax:985-384-3453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10075801261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center