Provider Demographics
NPI:1003801416
Name:KRAHL, VICKIE ANN (LSA)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:ANN
Last Name:KRAHL
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6864
Mailing Address - Country:US
Mailing Address - Phone:940-382-6757
Mailing Address - Fax:940-383-1894
Practice Address - Street 1:3320 COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6864
Practice Address - Country:US
Practice Address - Phone:940-382-6757
Practice Address - Fax:940-383-1894
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA0003246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89N936OtherBCBS