Individual
KRYSTLE DANELLE CHASE-CIRCELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
6450 LOUISIANA HIGHWAY 1, INNIS, LA 70747
(225) 492-3775
(225) 492-3782
Mailing address
6450 LOUISIANA HIGHWAY 1, BATCHELOR, LA 70715
(225) 492-3775
(225) 492-3782
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
302202
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2426982
—
LA
Enumeration date
08/02/2016
Last updated
05/05/2017
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