Provider Demographics
NPI:1649086893
Name:TYSON, KRYSHONNA
Entity type:Individual
Prefix:
First Name:KRYSHONNA
Middle Name:
Last Name:TYSON
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 1:6810 HOT SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75241-6910
Mailing Address - Country:US
Mailing Address - Phone:214-763-4518
Mailing Address - Fax:
Practice Address - Street 1:10100 N CENTRAL EXPY STE 595
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4140
Practice Address - Country:US
Practice Address - Phone:214-897-3565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker