Provider Demographics
NPI:1437044823
Name:TALLO, KRISTYN (PA)
Entity type:Individual
Prefix:
First Name:KRISTYN
Middle Name:
Last Name:TALLO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23154 WATERBUCK LAKE CT
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-7475
Mailing Address - Country:US
Mailing Address - Phone:225-810-2536
Mailing Address - Fax:
Practice Address - Street 1:42421 PELICAN PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-2405
Practice Address - Country:US
Practice Address - Phone:985-400-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA363A00000X207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology