NPIMap

Individual provider Active NPI

Kristen Hebert Hannaman, PA

  • Physician Assistant
  • Lake Charles, LA
National Provider Identifier
1063761898
Registry record updated Aug 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
782 Issued in LA
Practice address
1905 Country Club Rd
Lake Charles, LA 70605-5203
Phone
(337) 990-8000
Fax
(337) 990-8010
NPI assigned
Sep 7, 2012
Last updated
Aug 14, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 782 LA Primary

Addresses

Primary practice location

1905 Country Club Rd
Lake Charles, LA 70605-5203

Mailing address

10319 Jefferson Hwy
Baton Rouge, LA 70809-2730
Phone (225) 214-9352

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121101000584 LA Practitioner - Physician Assistant 7719137587 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Louisiana State University School of Medicine in Shreveport, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lake Charles Urgent CareGroup PAC ID 1052580644, 14 clinicians
Lcuc Family Physicians Urgent Care LLCGroup PAC ID 8325327935, 13 clinicians

Practice addresses (Care Compare)

1905 Country Club Rd
Lake Charles, LA 70605-5203
Phone (337) 990-8000

2400 Ryan St
Lake Charles, LA 70601-7322
Phone (337) 433-1260

301 S Cities Service Hwy
Sulphur, LA 70663-6405
Phone (337) 888-3171

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
782LAMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Charles Primary Care and Wellness Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376438400000",
    "number": "1063761898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10319 JEFFERSON HWY",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708092730",
            "telephone_number": "225-214-9352",
            "fax_number": "225-214-9349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 COUNTRY CLUB RD",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706055203",
            "telephone_number": "337-990-8000",
            "fax_number": "337-990-8010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANNAMAN",
        "first_name": "KRISTEN",
        "middle_name": "HEBERT",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-07",
        "last_updated": "2013-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "LA",
            "license": "782",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.