MEDICARE: KRISTIN ELIZABETH THEARD PMHNP-BC

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	243736	LA

General Provider Information

NPI Number	:	1568330793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN ELIZABETH THEARD PMHNP-BC

Provider Business Mailing Address
First Line	:	405 VENUS DR
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70501-2523
Country	:	US
Telephone Number	:	337-287-9377
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 CARMEL DR UNIT 102
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70501-5002
Country	:	US
Telephone Number	:	337-287-9377
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2025
Last Update Date	:	01/10/2026

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