Provider Demographics
NPI:1598179541
Name:HIXSON, KRISTA M (AT, ATC)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:M
Last Name:HIXSON
Suffix:
Gender:F
Credentials:AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9332 N 95TH WAY
Mailing Address - Street 2:104
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5536
Mailing Address - Country:US
Mailing Address - Phone:253-951-7012
Mailing Address - Fax:
Practice Address - Street 1:9332 N 95TH WAY
Practice Address - Street 2:104
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5536
Practice Address - Country:US
Practice Address - Phone:253-951-7012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer