Provider Demographics
NPI:1407207087
Name:CRIST, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:CRIST
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 1:1011 AVENUE F
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-7529
Mailing Address - Country:US
Mailing Address - Phone:561-389-0920
Mailing Address - Fax:561-839-3030
Practice Address - Street 1:1011 AVENUE F
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-7529
Practice Address - Country:US
Practice Address - Phone:561-389-0920
Practice Address - Fax:561-839-3030
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-25
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other