Provider Demographics
NPI:1124534458
Name:DAUPHINE, KRYSTAL ANN (MSW)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:ANN
Last Name:DAUPHINE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 EXCHANGE PL
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2510
Mailing Address - Country:US
Mailing Address - Phone:337-291-2815
Mailing Address - Fax:
Practice Address - Street 1:114 EXCHANGE PL
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503
Practice Address - Country:US
Practice Address - Phone:337-291-2815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-22
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator