Provider Demographics
NPI:1326356825
Name:KNUTSON, KRISTY A
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:A
Last Name:KNUTSON
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 1:425 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-2140
Mailing Address - Country:US
Mailing Address - Phone:541-261-3870
Mailing Address - Fax:
Practice Address - Street 1:425 N 9TH ST
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-2140
Practice Address - Country:US
Practice Address - Phone:541-261-3870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies