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General NPI Number Information
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NPI Number | 1710787197
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Entity Type | Individual
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Provider Name | KRYSTAL UKAEGBU RN, MSN
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Gender | Female
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Dates
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Enumeration Date | 03/15/2025
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 7000 FERN AVE APT 135
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City | SHREVEPORT
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State | LA
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Zip | 71105-4914
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Country | US
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Telephone | 318-658-8303
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Fax |
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Provider Business Mailing Address
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Address Line | 8880 BERNAY DR
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City | SHREVEPORT
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State | LA
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Zip | 71118-2024
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Country | US
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Telephone | 318-658-8303
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | RN131251
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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