Healthcare Provider Details

I. General information

NPI: 1285284612
Provider Name (Legal Business Name): KRYSTLE CASH-SHAW NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 BREAZEALE SPRINGS ST
NATCHITOCHES LA
71457-4278
US

IV. Provider business mailing address

447 BETHANY CHURCH RD
QUITMAN LA
71268-1025
US

V. Phone/Fax

Practice location:
  • Phone: 318-352-9299
  • Fax:
Mailing address:
  • Phone: 318-243-1904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number208051
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: