Provider Demographics
NPI:1851614036
Name:LEMLEY, KRISTA RENEE (DO)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:RENEE
Last Name:LEMLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 EAST EUREKA STREET
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-6520
Mailing Address - Country:US
Mailing Address - Phone:817-599-7373
Mailing Address - Fax:817-596-8889
Practice Address - Street 1:706 EAST EUREKA STREET
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-6520
Practice Address - Country:US
Practice Address - Phone:817-599-7373
Practice Address - Fax:817-596-8889
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP9085207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX337497701Medicaid
TX354282ZHAIMedicare PIN