Provider Demographics
NPI:1881470391
Name:MANCUSO, KRISTA (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:MANCUSO
Suffix:
Gender:
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4906 AMBASSADOR CAFFERY PKWY BLDG M
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6962
Mailing Address - Country:US
Mailing Address - Phone:337-534-8964
Mailing Address - Fax:
Practice Address - Street 1:4906 AMBASSADOR CAFFERY PKWY BLDG M
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6962
Practice Address - Country:US
Practice Address - Phone:337-534-8964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA232007363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily