Healthcare Provider Details

I. General information

NPI: 1922265560
Provider Name (Legal Business Name): KRISTEN P DICKINSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN P FRANKS APRN

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 TRI STATE DR
SAREPTA LA
71071-2826
US

IV. Provider business mailing address

106 TRI STATE DR
SAREPTA LA
71071-2826
US

V. Phone/Fax

Practice location:
  • Phone: 318-994-2266
  • Fax: 318-539-9177
Mailing address:
  • Phone: 318-994-2266
  • Fax: 318-539-9177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number05546
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: