KRYSTAL PEA (NPI# 1790158400) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790158400 |
| Entity Type | Individual |
| Full Name | KRYSTAL PEA |
| Practice Address |
2219 Claiborne Ave Shreveport LA 71103-4301 |
| Mailing Address |
4023 Esplanade Ave Shreveport LA 71109-5036 |
| Practice Telephone | 3187790434 |
| Practice Fax Number | 3182100000 |
| Mailing Telephone | 3185727418 |
| Enumeration Date | 2015-11-03 |
| Last Update Date | 2019-05-13 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers | ||
| Y | 101YP2500X |
Counselor Specialization: Professional |
5809 | LA | Behavioral Health & Social Service Providers |
| N | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 4023 Esplanade Ave, Shreveport, LA 71109 | 3185727418 |
| Street Address |
2219 CLAIBORNE AVE |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71103-4301 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679797286 | Armanda Y. Whitaker I | Counselor | 2219 Claiborne Ave, Shreveport, LA 71103-4301 | 2007-04-13 |
| 1134727704 | Ida Natasha Henderson | Case Manager/Care Coordinator | 2219 Claiborne Ave, Shreveport, LA 71103-4301 | 2020-10-15 |
| 1770100851 | Courtney Ukpabi | Case Manager/Care Coordinator | 2219 Claiborne Ave, Shreveport, LA 71103-4301 | 2020-07-06 |
| 1730713587 | Peggy B Mahoney-clark | Case Manager/Care Coordinator | 2219 Claiborne Ave, Shreveport, LA 71103-4301 | 2020-03-01 |
| 1396208088 | Kulicia Anderson | Case Manager/Care Coordinator | 2219 Claiborne Ave, Shreveport, LA 71103-4301 | 2019-04-09 |
| 1194294660 | Lisa Jones Battle | Case Manager/Care Coordinator | 2219 Claiborne Ave, Shreveport, LA 71103-4301 | 2018-11-14 |
| 1679051957 | Tasha Simpson | Social Worker | 2219 Claiborne Ave, Shreveport, LA 71103-4301 | 2018-07-30 |
| 1861978736 | Jutina Latson-cole | Social Worker | 2219 Claiborne Ave, Shreveport, LA 71103 | 2018-07-13 |
| 1407341746 | Shakisha Moore | Social Worker | 2219 Claiborne Ave, Shreveport, LA 71103-4301 | 2018-06-28 |
| 1457852014 | Jacqueline Wilson | Social Worker | 2219 Claiborne Ave, Shreveport, LA 71103-4301 | 2018-02-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083124887 | Elizabeth Ponder | Case Manager/Care Coordinator | 404 Hearne Avenue, Shreveport, LA 71103 | 2017-10-05 |
| 1245648393 | Madiha Tariq | General Acute Care Hospital | Rheumatology Clinic, 1501 Kings Hwy, Sheveport, LA 71103 | 2014-07-31 |
| 1659782688 | Jennifer G Smith | Pharmacist | 1725 Claiborne Ave, Shreveport, LA 71103 | 2014-05-13 |
| 1336568823 | Taylor Jieun Jung | Student in an Organized Health Care Education/Training Program | Lsu Health Sciences Center 1501 Kings Highway, Department of Oral & Maxillofacial Surgery Room 530, Shreveport, LA 71103 | 2014-04-10 |
| 1578984746 | Jamie Terrell | Pharmacist | 1625 Claiborne Ave, Shreveport, LA 71103 | 2013-12-13 |
| 1346675188 | Srijan Tandukar | Internal Medicine | 2751 Albert L Bicknell Dr Ste 2b, Shreveport, LA 71103 | 2013-09-12 |
| 1699017681 | Deanna Elise Mossallati | Internal Medicine | 8551 Greenwood Rd, Suite 410, Shreveport, LA 71103 | 2013-03-18 |
| 1346527330 | Tim M Smith | Clinical Exercise Physiologist | 3200 Greenwood Rd., Shreveport, LA 71103 | 2011-11-04 |
| 1144451683 | Second Chance Recovery | Durable Medical Equipment & Medical Supplies | 3816 Linwood, Shreveport, LA 71103 | 2009-07-31 |
| 1093919920 | Neeraj Singh | Internal Medicine | 2751 Albert L Bicknell Dr Fl 4, Shreveport, LA 71103 | 2007-06-13 |
| Find all providers in zip 71103 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801409313 | Divine Behavioral Health, LLC | Counselor | 8870 Youree Dr Ste 105, Shreveport, LA 71115-2512 | 2020-08-25 |
| 1912519083 | Tashara D Williams | Counselor | 3615 Crestview Cir, Shreveport, LA 71119-6522 | 2020-08-20 |
| 1528689213 | Whitfield Counseling Services | Counselor | 2924 Knight St Ste 410, Shreveport, LA 71105-2413 | 2020-05-04 |
| 1376172908 | Lajuana Stephens | Counselor | 7318 Winder Dr, Shreveport, LA 71129-4013 | 2020-04-06 |
| 1417503723 | Beyond The Crossroads Counseling Center, LLC | Counselor | 3321 Youree Dr Ste E, Shreveport, LA 71105-2123 | 2019-08-13 |
| 1336702950 | Terrance Toney Sr. | Counselor | 272 E 78th St, Shreveport, LA 71106-5602 | 2019-04-18 |
| 1922564327 | Briana A Craige | Counselor | 6009 Financial Plz # 102, Shreveport, LA 71129-2615 | 2019-02-11 |
| 1518434182 | Road To Change | Counselor | 2620 Centenary Blvd Ste 204, Shreveport, LA 71104-3350 | 2018-10-31 |
| 1619455649 | Kindled Keys of Counseling, LLC | Counselor | 1737 Boykin Blvd, Shreveport, LA 71107-6108 | 2018-08-01 |
| 1174040646 | Khakillya Babers Everett | Counselor | 8214 Green Leaf Ln, Shreveport, LA 71108-5738 | 2017-08-25 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71103 |
Please comment or provide details below to improve the information on KRYSTAL PEA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.