Healthcare Provider Details

I. General information

NPI: 1609765486
Provider Name (Legal Business Name): KRISTY D NGUYEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 BARATARIA BLVD
MARRERO LA
70072-3769
US

IV. Provider business mailing address

7420 HESS DR
MARRERO LA
70072-5993
US

V. Phone/Fax

Practice location:
  • Phone: 504-340-6711
  • Fax:
Mailing address:
  • Phone: 504-428-4926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number348675
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: