=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164217576
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRYSTLE LASHAUN PARIS FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2025
-----------------------------------------------------
Last Update Date | 07/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 703 E MARSHALL AVE STE 5008
-----------------------------------------------------
City | LONGVIEW
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75601-5557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-315-4455
-----------------------------------------------------
Fax | 903-315-2466
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 431 EASTSIDE RD
-----------------------------------------------------
City | LONGVIEW
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75603-6382
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-235-9809
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 1195183
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------