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NPI Code Detail

MEDICARE: KRISTY RENEE MCCOMIC RN

MEDICARE: KRISTY RENEE MCCOMIC RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WC0400XCase Management Registered Nurse070301LA

General Provider Information

NPI Number : 1114517406
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTY RENEE MCCOMIC RN
Provider Business Mailing Address
First Line : 1585 3RD ST BLDG 285
Second Line :
City : FORT POLK
State : LA
Zip : 71459-5102
Country : US
Telephone Number : 337-531-3561
Fax Number : 337-531-3428
Provider Business Practice Location Address
First Line : 1585 3RD STREET BUILDING 285
Second Line : ATTENTION: CREDENTIALS, ROOM 7064
City : FORT POLK
State : LA
Zip : 71459
Country : US
Telephone Number : 337-531-3561
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2021
Last Update Date : 01/21/2021

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