Provider Demographics
NPI:1245571397
Name:FOX, KRISTY D (CH, RM, CLC)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:D
Last Name:FOX
Suffix:
Gender:F
Credentials:CH, RM, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHARPSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16150-2055
Mailing Address - Country:US
Mailing Address - Phone:724-498-4276
Mailing Address - Fax:724-498-4876
Practice Address - Street 1:513 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SHARPSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16150-2055
Practice Address - Country:US
Practice Address - Phone:724-498-4276
Practice Address - Fax:724-498-4876
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker