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General NPI Number Information
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NPI Number | 1437044823
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Entity Type | Individual
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Provider Name | KRISTYN TALLO PA
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Gender | Female
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Dates
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Enumeration Date | 06/09/2025
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 42421 PELICAN PROFESSIONAL PARK
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City | HAMMOND
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State | LA
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Zip | 70403-2405
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Country | US
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Telephone | 985-400-5551
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Fax |
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Provider Business Mailing Address
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Address Line | 23154 WATERBUCK LAKE CT
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City | DENHAM SPRINGS
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State | LA
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Zip | 70726-7475
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Country | US
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Telephone | 225-810-2536
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 363A00000X
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License Number State | LA
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