Provider Demographics
NPI:1659956993
Name:AMASON, KRISTY SUSAN
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:SUSAN
Last Name:AMASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 NORTHTOWN DR # 110
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-3016
Mailing Address - Country:US
Mailing Address - Phone:601-206-9195
Mailing Address - Fax:
Practice Address - Street 1:309 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:MS
Practice Address - Zip Code:39153-6011
Practice Address - Country:US
Practice Address - Phone:601-782-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist