Provider Demographics
NPI:1689095432
Name:RABALAIS, KRISTI CROCHET (NP)
Entity Type:Individual
Prefix:MS
First Name:KRISTI
Middle Name:CROCHET
Last Name:RABALAIS
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4463 LA HIGHWAY 1 S
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORT ALLEN
Mailing Address - State:LA
Mailing Address - Zip Code:70767-5989
Mailing Address - Country:US
Mailing Address - Phone:225-448-5307
Mailing Address - Fax:225-687-6669
Practice Address - Street 1:4463 LA HIGHWAY 1 S
Practice Address - Street 2:SUITE A
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767-5989
Practice Address - Country:US
Practice Address - Phone:225-448-5307
Practice Address - Fax:225-687-6669
Is Sole Proprietor?:No
Enumeration Date:2013-12-20
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LARN104995AP07666363LP0200X
LAAP07666363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2359690Medicaid
LA2359690Medicaid