Healthcare Provider Details

I. General information

NPI: 1407239395
Provider Name (Legal Business Name): KRYSTAL AMBER YOUNT CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4864 JACKSON ST
MONROE LA
71202-6400
US

IV. Provider business mailing address

623 OAK KNOLL ST
MINDEN LA
71055-2640
US

V. Phone/Fax

Practice location:
  • Phone: 318-330-7169
  • Fax: 318-330-7648
Mailing address:
  • Phone: 318-560-7423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN136124/AP08401
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: