Healthcare Provider Details

I. General information

NPI: 1093695652
Provider Name (Legal Business Name): KRYSTAL BOSIO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRYSTAL SHANNON STANN

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 N HIGHWAY 190
COVINGTON LA
70433-5364
US

IV. Provider business mailing address

PO BOX 3370
COVINGTON LA
70434-3370
US

V. Phone/Fax

Practice location:
  • Phone: 985-867-8585
  • Fax: 985-867-3644
Mailing address:
  • Phone: 985-867-8585
  • Fax: 985-867-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number242979
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: