Provider Demographics
NPI:1285663807
Name:BRAUD, KRISTY L (MD)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:L
Last Name:BRAUD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 BERT KOUNS LOOP
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3133
Mailing Address - Country:US
Mailing Address - Phone:318-687-5277
Mailing Address - Fax:318-687-5386
Practice Address - Street 1:2508 BERT KOUNS LOOP
Practice Address - Street 2:SUITE 103
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3133
Practice Address - Country:US
Practice Address - Phone:318-687-5277
Practice Address - Fax:318-687-5386
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023576207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1486515Medicaid
LAH17406Medicare UPIN
LA1486515Medicaid
LA5H335DC14Medicare PIN