Basic Information
| Provider Information | |||||||||
| NPI: | 1558346817 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STARKOVICH | ||||||||
| FirstName: | KRISTINE | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60475 | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705960475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3379881890 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4212 W CONGRESS ST | ||||||||
| Address2: | SUITE 3200 | ||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705066765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3379813546 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2005 | ||||||||
| LastUpdateDate: | 05/24/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | AP01504 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 1980650 | 05 | LA | MEDICAID |