Provider Demographics
NPI:1508522004
Name:MYERS, KRYSTAL JUNE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:KRYSTAL
Middle Name:JUNE
Last Name:MYERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17804 BLACK STALLION WAY
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-4412
Mailing Address - Country:US
Mailing Address - Phone:202-815-2370
Mailing Address - Fax:
Practice Address - Street 1:17804 BLACK STALLION WAY
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-4412
Practice Address - Country:US
Practice Address - Phone:202-815-2370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP55945164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse