Provider Demographics
NPI:1043638406
Name:RIBEIRO, KRYSTAL LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:KRYSTAL
Middle Name:LYNN
Last Name:RIBEIRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:LYNN
Other - Last Name:CARLOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:200 STONECREST BLVD
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167
Mailing Address - Country:US
Mailing Address - Phone:615-768-2000
Mailing Address - Fax:
Practice Address - Street 1:9880 W FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8085
Practice Address - Country:US
Practice Address - Phone:702-216-7335
Practice Address - Fax:702-243-2560
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.129612207P00000X
NV18758207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine