Provider Demographics
NPI:1659588671
Name:ROY, KRISTINA ANNE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:ANNE
Last Name:ROY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8304 92ND ST SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-4603
Mailing Address - Country:US
Mailing Address - Phone:253-431-3062
Mailing Address - Fax:253-588-2366
Practice Address - Street 1:8509 STEILACOOM BLVD SW
Practice Address - Street 2:SUITE D
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-4786
Practice Address - Country:US
Practice Address - Phone:253-588-2366
Practice Address - Fax:253-588-2383
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019653174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist