Provider Demographics
NPI:1245017094
Name:MANUEL, KRISTIN KING (FNP-C, APRN)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:KING
Last Name:MANUEL
Suffix:
Gender:
Credentials:FNP-C, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 WILLOW BROOK AVE
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-2710
Mailing Address - Country:US
Mailing Address - Phone:225-421-6704
Mailing Address - Fax:
Practice Address - Street 1:54016 HIGHWAY 1062
Practice Address - Street 2:
Practice Address - City:LORANGER
Practice Address - State:LA
Practice Address - Zip Code:70446-3538
Practice Address - Country:US
Practice Address - Phone:985-606-9000
Practice Address - Fax:985-878-9568
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN152976163W00000X
LAF07230967363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse