Provider Demographics
NPI:1770807943
Name:SUBLETT, KRYSTAL DEEANN
Entity type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:DEEANN
Last Name:SUBLETT
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KRYSTALL
Other - Middle Name:DEEANN
Other - Last Name:HULSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3204 E MOORE ST
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4826
Mailing Address - Country:US
Mailing Address - Phone:501-268-7777
Mailing Address - Fax:
Practice Address - Street 1:3204 E MOORE ST
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4826
Practice Address - Country:US
Practice Address - Phone:501-268-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator