Healthcare Provider Details

I. General information

NPI: 1568232882
Provider Name (Legal Business Name): KRISTEN EYMARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/08/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38099 POST OFFICE ROAD SUITE 10
PRAIRIEVILLE LA
70769
US

IV. Provider business mailing address

104 N AIRLINE HWY STE 148
GONZALES LA
70737-3023
US

V. Phone/Fax

Practice location:
  • Phone: 225-263-3835
  • Fax:
Mailing address:
  • Phone: 225-263-3835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14265
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: