Provider Demographics
NPI:1477110120
Name:KYSER, KRISTY LEIGH (LAT, MHS)
Entity Type:Individual
Prefix:MS
First Name:KRISTY
Middle Name:LEIGH
Last Name:KYSER
Suffix:
Gender:F
Credentials:LAT, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:WOLFFORTH
Mailing Address - State:TX
Mailing Address - Zip Code:79382-3326
Mailing Address - Country:US
Mailing Address - Phone:512-970-3893
Mailing Address - Fax:
Practice Address - Street 1:3506 21ST ST STE 507
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1233
Practice Address - Country:US
Practice Address - Phone:806-725-4802
Practice Address - Fax:806-723-7790
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT56012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer