Provider Demographics
NPI:1942825831
Name:SQUYRES, KRISTYN DEVUN (FNP)
Entity Type:Individual
Prefix:
First Name:KRISTYN
Middle Name:DEVUN
Last Name:SQUYRES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 FORSYTHE AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3010
Mailing Address - Country:US
Mailing Address - Phone:318-600-4364
Mailing Address - Fax:318-605-3149
Practice Address - Street 1:2900 FORSYTHE AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3010
Practice Address - Country:US
Practice Address - Phone:318-600-4364
Practice Address - Fax:318-605-3149
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA213774363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily