Provider Demographics
NPI:1750042602
Name:HOWARD, KRYSTAL L
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:L
Last Name:HOWARD
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 1:804 STRAWBERRY POINTE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-9555
Mailing Address - Country:US
Mailing Address - Phone:769-666-0402
Mailing Address - Fax:
Practice Address - Street 1:3466 N LIBERTY ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-3716
Practice Address - Country:US
Practice Address - Phone:769-666-0402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No347C00000XTransportation ServicesPrivate Vehicle