Provider Demographics
NPI:1669895546
Name:ELLIOTT, KRISTY LATOYA (HAIR LOSS SPECAILIST)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:LATOYA
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:HAIR LOSS SPECAILIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 6TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-1727
Mailing Address - Country:US
Mailing Address - Phone:205-523-1385
Mailing Address - Fax:
Practice Address - Street 1:2615 6TH ST STE 1
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-1727
Practice Address - Country:US
Practice Address - Phone:205-523-1385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management