Provider Demographics
NPI:1710511241
Name:HEBERT, CRYSTAL CARACCIOLI (PMHNP)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:CARACCIOLI
Last Name:HEBERT
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5131 ODONOVAN DR STE 300
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4792
Mailing Address - Country:US
Mailing Address - Phone:225-374-0400
Mailing Address - Fax:225-374-0430
Practice Address - Street 1:5131 ODONOVAN DR STE 300
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4792
Practice Address - Country:US
Practice Address - Phone:225-374-0400
Practice Address - Fax:225-374-0430
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA211927363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health