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General NPI Number Information
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NPI Number | 1881733673
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Entity Type | Individual
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Provider Name | KRISTA PHILLIPS CONNELL
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Gender | Female
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 05/22/2012
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Provider Practice Location Address
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Address Line | 3501 HIGHWAY 10
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City | JACKSON
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State | LA
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Zip | 70748-6238
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Country | US
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Telephone | 225-683-5292
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Fax | 225-683-3411
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Provider Business Mailing Address
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Address Line | PO BOX 395
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City | CLINTON
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State | LA
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Zip | 70722-0395
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Country | US
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Telephone | 225-683-5292
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Fax | 225-683-3411
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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 | AP05081
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License Number State | LA
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