Healthcare Provider Details

I. General information

NPI: 1013238997
Provider Name (Legal Business Name): KRISTY LANDRY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 GOODLETTE RD SUITE 302,3RD FLOOR
NAPLES FL
34102-5644
US

IV. Provider business mailing address

PO BOX 749495
ATLANTA GA
30374-9495
US

V. Phone/Fax

Practice location:
  • Phone: 239-231-7260
  • Fax: 239-567-3667
Mailing address:
  • Phone: 855-963-2100
  • Fax: 813-321-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9103782
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: