Healthcare Provider Details

I. General information

NPI: 1164217576
Provider Name (Legal Business Name): KRYSTLE LASHAUN PARIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 E MARSHALL AVE STE 5008
LONGVIEW TX
75601-5557
US

IV. Provider business mailing address

431 EASTSIDE RD
LONGVIEW TX
75603-6382
US

V. Phone/Fax

Practice location:
  • Phone: 903-315-4455
  • Fax: 903-315-2466
Mailing address:
  • Phone: 903-235-9809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1195183
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: