Provider Demographics
NPI:1609524099
Name:THOMAS, KRYSTLE (CD)
Entity Type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 HORTON DR
Mailing Address - Street 2:
Mailing Address - City:SEAGOVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75159-5449
Mailing Address - Country:US
Mailing Address - Phone:972-793-2652
Mailing Address - Fax:
Practice Address - Street 1:2511 HORTON DR
Practice Address - Street 2:
Practice Address - City:SEAGOVILLE
Practice Address - State:TX
Practice Address - Zip Code:75159-5449
Practice Address - Country:US
Practice Address - Phone:972-793-2652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula