Provider Demographics
NPI:1376164723
Name:WOOD, KRYSTAL ANNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRYSTAL
Middle Name:ANNE
Last Name:WOOD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 TURNER ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32508-5211
Mailing Address - Country:US
Mailing Address - Phone:850-452-5242
Mailing Address - Fax:
Practice Address - Street 1:605 E HOLLY ST APT 206
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-7882
Practice Address - Country:US
Practice Address - Phone:717-919-5479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-27
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810007416103TC0700X
MI6301018209390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program