Provider Demographics
NPI:1154075505
Name:KRYSTAL KOLLET LLC
Entity Type:Organization
Organization Name:KRYSTAL KOLLET LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:281-865-2092
Mailing Address - Street 1:18243 RUSSETT GREEN DR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-4130
Mailing Address - Country:US
Mailing Address - Phone:281-865-2092
Mailing Address - Fax:281-214-0456
Practice Address - Street 1:18243 RUSSETT GREEN DR
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-4130
Practice Address - Country:US
Practice Address - Phone:281-865-2092
Practice Address - Fax:281-214-0456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory