Provider Demographics
NPI:1184900136
Name:MCCANTS, KRYSTAL MARIE
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:MARIE
Last Name:MCCANTS
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 1:63 PETTY DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-3957
Mailing Address - Country:US
Mailing Address - Phone:513-446-9221
Mailing Address - Fax:
Practice Address - Street 1:63 PETTY DR
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-3957
Practice Address - Country:US
Practice Address - Phone:513-709-4071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2012-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400975320909376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide