Provider Demographics
NPI:1750900726
Name:CRISSEY, KIMBERLY (DOCTOR)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:CRISSEY
Suffix:
Gender:F
Credentials:DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-4890
Mailing Address - Country:US
Mailing Address - Phone:605-665-8197
Mailing Address - Fax:605-668-2787
Practice Address - Street 1:3001 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-4890
Practice Address - Country:US
Practice Address - Phone:605-665-8197
Practice Address - Fax:605-668-2787
Is Sole Proprietor?:No
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD6188183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist