Provider Demographics
NPI:1346940806
Name:SMITH, KRISTA KAY
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:KAY
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:KAY-SMITH
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4491 LONG PRAIRIE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1795
Mailing Address - Country:US
Mailing Address - Phone:469-687-9184
Mailing Address - Fax:
Practice Address - Street 1:4491 LONG PRAIRIE RD STE 300
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1795
Practice Address - Country:US
Practice Address - Phone:469-687-9184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician