Provider Demographics
NPI:1801823323
Name:LAFAYE, KRISTINA M (MD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:M
Last Name:LAFAYE
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 1:1430 TULANE AVE
Mailing Address - Street 2:#8065
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2632
Mailing Address - Country:US
Mailing Address - Phone:504-988-1133
Mailing Address - Fax:504-988-9191
Practice Address - Street 1:1430 TULANE AVE
Practice Address - Street 2:#8065
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2632
Practice Address - Country:US
Practice Address - Phone:504-988-1133
Practice Address - Fax:504-988-9191
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.0248072084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1047295Medicaid
136844Medicare UPIN
LA4J7846629Medicare PIN
LA1047295Medicaid