Healthcare Provider Details

I. General information

NPI: 1710309166
Provider Name (Legal Business Name): KRISTEN MUSCARELLO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2014
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52579 HIGHWAY 51 S
INDEPENDENCE LA
70443-2231
US

IV. Provider business mailing address

52579 HIGHWAY 51 S
INDEPENDENCE LA
70443-2231
US

V. Phone/Fax

Practice location:
  • Phone: 985-878-9421
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP07639
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: