Healthcare Provider Details

I. General information

NPI: 1700746427
Provider Name (Legal Business Name): KRYSTAL PAULSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 HEYMANN BLVD
LAFAYETTE LA
70503-2322
US

IV. Provider business mailing address

106 HEYMANN BLVD
LAFAYETTE LA
70503-2322
US

V. Phone/Fax

Practice location:
  • Phone: 337-267-0407
  • Fax:
Mailing address:
  • Phone: 337-267-0407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number218506
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: