Provider Demographics
NPI:1841838125
Name:CRIM, KELLY D (NP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:D
Last Name:CRIM
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:337-470-4881
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:4809 AMBASSADOR CAFFERY PKWY STE 410
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-8802
Practice Address - Country:US
Practice Address - Phone:337-470-4881
Practice Address - Fax:337-470-4882
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2024-08-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA214884363L00000X
MS903261363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA214884OtherLICENSE
MS640604703OtherLAKELAND SURGICAL CLINIC, PLLC