Krystal Lynn Kouder, RN, IBCLC

Primary specialty

Lactation Consultant (Registered Nurse)Taxonomy code 163WL0100X

License

28156517A Issued in IN

Practice address

5843 Tahoe PL
Cedar Lake, IN 46303-0676

Phone

(843) 743-9099

NPI assigned

Oct 5, 2021

Reactivated

Mar 22, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1633392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647907200000",
    "number": "1639831860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5843 TAHOE PL",
            "city": "CEDAR LAKE",
            "state": "IN",
            "postal_code": "463030676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5843 TAHOE PL",
            "city": "CEDAR LAKE",
            "state": "IN",
            "postal_code": "463030676",
            "telephone_number": "843-743-9099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOUDER",
        "first_name": "KRYSTAL",
        "middle_name": "LYNN",
        "credential": "RN, IBCLC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-05",
        "last_updated": "2022-03-22",
        "certification_date": "2022-03-22",
        "deactivation_date": "2021-11-30",
        "reactivation_date": "2022-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WL0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "IN",
            "license": "28156517A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Lactation Consultant (Registered Nurse) in Cedar Lake, IN
• Providers in Cedar Lake, IN by specialty
• Lactation Consultant (Registered Nurse) in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.