Provider Demographics
NPI:1053549725
Name:LAGARDE, KRISTIN FIKES (FNP)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:FIKES
Last Name:LAGARDE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-579-5430
Mailing Address - Fax:601-268-5819
Practice Address - Street 1:415 S 28TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7246
Practice Address - Country:US
Practice Address - Phone:601-579-5430
Practice Address - Fax:601-268-5819
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR872859363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00805325Medicaid
MS6179919OtherCIGNA
MSP00844125OtherRAILROAD MEDICARE
MS302I503371Medicare PIN