Provider Demographics
NPI:1649775685
Name:FRALEY, KRYSTLE GARCIA (DO)
Entity Type:Individual
Prefix:DR
First Name:KRYSTLE
Middle Name:GARCIA
Last Name:FRALEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KRYSTLE
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:395 W 12TH AVE RM 414
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1267
Mailing Address - Country:US
Mailing Address - Phone:614-685-0759
Mailing Address - Fax:614-293-6935
Practice Address - Street 1:395 W 12TH AVE RM 414
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1267
Practice Address - Country:US
Practice Address - Phone:614-685-0759
Practice Address - Fax:614-293-6935
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
OH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program