Provider Demographics
NPI:1609653823
Name:MOORE, KRISTY CLEMENT
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:CLEMENT
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KRISTY
Other - Middle Name:LYNN
Other - Last Name:CLEMENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2732
Mailing Address - Country:US
Mailing Address - Phone:985-876-7400
Mailing Address - Fax:
Practice Address - Street 1:2550 COTEAU RD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70364-1205
Practice Address - Country:US
Practice Address - Phone:985-868-4267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA48502355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant