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Individual

MS. KRYSTAL UKAEGBU

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RN, MSN

Contact information

Practice address
7000 FERN AVE APT 135, SHREVEPORT, LA 71105-4914
(318) 658-8303
Mailing address
8880 BERNAY DR, SHREVEPORT, LA 71118-2024
(318) 658-8303

Taxonomy

Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
RN131251
LA
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

Other

Enumeration date
03/15/2025
Last updated
07/09/2025
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