Provider Demographics
NPI:1649221839
Name:WALTMAN, KRISTY M (MD)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:M
Last Name:WALTMAN
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 1:8001 YOUREE DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2302
Mailing Address - Country:US
Mailing Address - Phone:318-212-3890
Mailing Address - Fax:318-212-3888
Practice Address - Street 1:8001 YOUREE DR
Practice Address - Street 2:SUITE 600
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-2302
Practice Address - Country:US
Practice Address - Phone:318-212-3890
Practice Address - Fax:318-212-3888
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022395207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1495921Medicaid
LA5H543Medicare PIN
LA5H543CV71Medicare UPIN
LA1495921Medicaid