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General NPI Number Information
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NPI Number | 1649635921
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Entity Type | Individual
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Provider Name | LOUISE CRISTO NP-C
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Gender | Female
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Dates
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Enumeration Date | 12/30/2015
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Last Update Date | 12/30/2015
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Provider Practice Location Address
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Address Line | 739 S FOURTH ST
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City | BALDWYN
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State | MS
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Zip | 38824-2612
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Country | US
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Telephone | 662-401-1472
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Fax |
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Provider Business Mailing Address
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Address Line | 747 HIGHWAY 366
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City | BALDWYN
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State | MS
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Zip | 38824-8922
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Country | US
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Telephone | 662-401-1472
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | CRIS-BWTE5X
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License Number State | MS
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