Provider Demographics
NPI:1356711998
Name:MUMPHREY, KRISTINA
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:MUMPHREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISSI
Other - Middle Name:
Other - Last Name:DUNCAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3272 REINE AVE
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-5032
Mailing Address - Country:US
Mailing Address - Phone:225-335-3052
Mailing Address - Fax:
Practice Address - Street 1:3272 REINE AVE
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-5032
Practice Address - Country:US
Practice Address - Phone:225-335-3052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-25
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator