Healthcare Provider Details

I. General information

NPI: 1144977208
Provider Name (Legal Business Name): KRISTIN OBRIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 03/08/2022
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 S CLEARVIEW PKWY
HARAHAN LA
70123-3401
US

IV. Provider business mailing address

822 S CLEARVIEW PKWY
HARAHAN LA
70123-3401
US

V. Phone/Fax

Practice location:
  • Phone: 504-736-7391
  • Fax:
Mailing address:
  • Phone: 504-736-7391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN126479
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: