MEDICARE: KRISTIE PETE 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
1	163W00000X	Registered Nurse	139801	LA

General Provider Information

NPI Number	:	1952053415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIE PETE RN

Provider Business Mailing Address
First Line	:	3443 WATERVIEW DR
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70607-1006
Country	:	US
Telephone Number	:	337-884-4934
Fax Number	:

Provider Business Practice Location Address
First Line	:	3443 WATERVIEW DR
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70607-1006
Country	:	US
Telephone Number	:	337-884-4934
Fax Number	:

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

Provider Enumeration Date	:	01/25/2022
Last Update Date	:	01/25/2022

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