Healthcare Provider Details

I. General information

NPI: 1245017094
Provider Name (Legal Business Name): KRISTIN KING MANUEL FNP-C, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 BENTON LN
DENHAM SPRINGS LA
70726-4516
US

IV. Provider business mailing address

1680 BENTON LN
DENHAM SPRINGS LA
70726-4516
US

V. Phone/Fax

Practice location:
  • Phone: 225-243-5218
  • Fax: 225-243-5225
Mailing address:
  • Phone: 225-243-5218
  • Fax: 225-243-5225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF07230967
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN152976
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: