Provider Demographics
NPI:1083181705
Name:CLOUD-THOMPSON, KRYSTIN
Entity Type:Individual
Prefix:
First Name:KRYSTIN
Middle Name:
Last Name:CLOUD-THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1349 CORPORATE SQUARE DR STE 2
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-3157
Mailing Address - Country:US
Mailing Address - Phone:985-445-1488
Mailing Address - Fax:985-445-1489
Practice Address - Street 1:1349 CORPORATE SQUARE DR STE 2
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-3157
Practice Address - Country:US
Practice Address - Phone:985-445-1488
Practice Address - Fax:985-445-1489
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator