Provider Demographics
NPI:1255500245
Name:PRICE, KRYSTAL DAWN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:DAWN
Last Name:PRICE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-2582
Mailing Address - Country:US
Mailing Address - Phone:419-443-8877
Mailing Address - Fax:419-443-8885
Practice Address - Street 1:716 W MARKET ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-2582
Practice Address - Country:US
Practice Address - Phone:419-443-8877
Practice Address - Fax:419-443-8885
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33011751174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist