Provider Demographics
NPI:1235810359
Name:FREDERICK, KRYSTLE C (RN)
Entity Type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:C
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 JUNELL STREET #A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77088
Mailing Address - Country:US
Mailing Address - Phone:732-801-5220
Mailing Address - Fax:
Practice Address - Street 1:1014 JUNELL STREET #A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088
Practice Address - Country:US
Practice Address - Phone:732-801-5220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1014279163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse