Provider Demographics
NPI:1093598138
Name:LEMMON, KRISTY (YOGA INSTRUCTOR)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:LEMMON
Suffix:
Gender:F
Credentials:YOGA INSTRUCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3423 NEW BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-3137
Mailing Address - Country:US
Mailing Address - Phone:210-860-3493
Mailing Address - Fax:
Practice Address - Street 1:200 E BROAD ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-5904
Practice Address - Country:US
Practice Address - Phone:210-860-3493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach