Provider Demographics
NPI:1093268963
Name:HEBERT, KRISTEN ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:ELIZABETH
Last Name:HEBERT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:KRISTEN
Other - Middle Name:HEBERT
Other - Last Name:MCGHEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 1160
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-1160
Mailing Address - Country:US
Mailing Address - Phone:225-654-1124
Mailing Address - Fax:225-654-7079
Practice Address - Street 1:20474 OLD SCENIC HWY
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-7365
Practice Address - Country:US
Practice Address - Phone:225-654-1124
Practice Address - Fax:225-654-7079
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA302200363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant