Provider Demographics
NPI:1659459683
Name:HYMES, CRITTY LILLETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:CRITTY
Middle Name:LILLETTE
Last Name:HYMES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CRITTY
Other - Middle Name:HYMES
Other - Last Name:BLACKNELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:13328 HAYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70128-1511
Mailing Address - Country:US
Mailing Address - Phone:504-615-0558
Mailing Address - Fax:
Practice Address - Street 1:5640 READ BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-3140
Practice Address - Country:US
Practice Address - Phone:504-246-8860
Practice Address - Fax:504-245-7972
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAR3818174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1167762Medicaid
LA07-96527OtherUNITED HEALTH CARE
LA07-96527OtherUNITED HEALTH CARE