Provider Demographics
NPI:1013238997
Name:LANDRY, KRISTY (PA)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:LANDRY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1064 GOODLETTE RD N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5449
Mailing Address - Country:US
Mailing Address - Phone:239-649-1186
Mailing Address - Fax:239-649-1156
Practice Address - Street 1:1064 GOODLETTE RD N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5449
Practice Address - Country:US
Practice Address - Phone:239-649-1186
Practice Address - Fax:239-649-1156
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103782363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant