Provider Demographics
NPI:1629898796
Name:CRISP, KATHERINE CHEYENNE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:CHEYENNE
Last Name:CRISP
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 1:120 E DAY ST
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75021-4801
Mailing Address - Country:US
Mailing Address - Phone:580-579-9551
Mailing Address - Fax:
Practice Address - Street 1:120 E DAY ST
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75021-4801
Practice Address - Country:US
Practice Address - Phone:580-579-9551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant