Provider Demographics
NPI:1639108525
Name:CHARBONNET, KRISTY ASHTON (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:ASHTON
Last Name:CHARBONNET
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 952346
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31192-2316
Mailing Address - Country:US
Mailing Address - Phone:504-454-0141
Mailing Address - Fax:
Practice Address - Street 1:3798 VETERANS MEMORIAL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-5837
Practice Address - Country:US
Practice Address - Phone:504-454-0141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04096363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1151602Medicaid
LAP73646Medicare UPIN