Provider Demographics
NPI:1932700630
Name:COUCH, KRISTIN LEONIE MAYER
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:LEONIE MAYER
Last Name:COUCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25010 BURVANT STREET
Mailing Address - Street 2:
Mailing Address - City:ABITA SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70420
Mailing Address - Country:US
Mailing Address - Phone:504-339-7175
Mailing Address - Fax:
Practice Address - Street 1:25010 BURVANT STREET
Practice Address - Street 2:
Practice Address - City:ABITA SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70420
Practice Address - Country:US
Practice Address - Phone:504-339-7175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-08
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN152846163W00000X
LA227675363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse