Provider Demographics
NPI:1073067112
Name:KRIZAN, STACY
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:
Last Name:KRIZAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 LA MESA AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79107-6220
Mailing Address - Country:US
Mailing Address - Phone:806-340-5250
Mailing Address - Fax:
Practice Address - Street 1:1301 LA MESA AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79107-6220
Practice Address - Country:US
Practice Address - Phone:806-340-5250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-06
Last Update Date:2016-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81-3473370332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies