Provider Demographics
NPI:1780293878
Name:CORNERSTONE CHILDRENS CLINIC LLC
Entity type:Organization
Organization Name:CORNERSTONE CHILDRENS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NP
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:985-320-9734
Mailing Address - Street 1:30892 HIGHWAY 43
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:LA
Mailing Address - Zip Code:70711-2814
Mailing Address - Country:US
Mailing Address - Phone:225-567-2812
Mailing Address - Fax:225-567-2812
Practice Address - Street 1:44546 S AIRPORT RD STE F
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-0312
Practice Address - Country:US
Practice Address - Phone:225-567-2812
Practice Address - Fax:225-567-2812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty