Provider Demographics
NPI:1215581723
Name:ERNST, CRYSTAL KAY
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:KAY
Last Name:ERNST
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 1:727 N WACO AVE STE 165
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-3987
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13201 E MAPLE GROVE RD
Practice Address - Street 2:
Practice Address - City:MOUNT HOPE
Practice Address - State:KS
Practice Address - Zip Code:67108-9008
Practice Address - Country:US
Practice Address - Phone:316-259-0801
Practice Address - Fax:316-444-2217
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS473338739OtherHOME HEALTH CARE SERVICES