Provider Demographics
NPI:1649635921
Name:CRISTO, LOUISE (NP-C)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:
Last Name:CRISTO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 HIGHWAY 366
Mailing Address - Street 2:
Mailing Address - City:BALDWYN
Mailing Address - State:MS
Mailing Address - Zip Code:38824-8922
Mailing Address - Country:US
Mailing Address - Phone:662-401-1472
Mailing Address - Fax:
Practice Address - Street 1:739 S FOURTH ST
Practice Address - Street 2:
Practice Address - City:BALDWYN
Practice Address - State:MS
Practice Address - Zip Code:38824-2612
Practice Address - Country:US
Practice Address - Phone:662-401-1472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSCRIS-BWTE5X363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner