Provider Demographics
NPI:1659269124
Name:ASHLEY, KRYSTAL DIANE
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:DIANE
Last Name:ASHLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:DIANE
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:ANADARKO
Mailing Address - State:OK
Mailing Address - Zip Code:73005-0325
Mailing Address - Country:US
Mailing Address - Phone:405-482-3414
Mailing Address - Fax:
Practice Address - Street 1:1362 WATSON DR APT 35
Practice Address - Street 2:
Practice Address - City:ANADARKO
Practice Address - State:OK
Practice Address - Zip Code:73005-2266
Practice Address - Country:US
Practice Address - Phone:405-482-3414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty