Individual
KRISTY D MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
401 E VAUGHN AVE, RUSTON, LA 71270-5950
(318) 254-2100
Mailing address
771 HIGHWAY 1228, WINNFIELD, LA 71483-7532
(318) 254-2557
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
074320
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
074320
CRNA CERTIFICATION NO.
LA
05
—
1024252
—
LA
01
—
H6497
BLUE CROSS BLUE SHIELD
LA
Enumeration date
03/29/2007
Last updated
02/18/2008
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