Provider Demographics
NPI:1891105151
Name:LYNN, KRISTY ANNE (ACA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:ANNE
Last Name:LYNN
Suffix:
Gender:F
Credentials:ACA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 OLIVE ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2246
Mailing Address - Country:US
Mailing Address - Phone:318-459-9125
Mailing Address - Fax:
Practice Address - Street 1:745 OLIVE ST
Practice Address - Street 2:SUITE 212
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2246
Practice Address - Country:US
Practice Address - Phone:318-459-9125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAACA200049171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist