Provider Demographics
NPI:1780322578
Name:RACKLEY, KRYSTAL S
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:S
Last Name:RACKLEY
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 1:1000 LEROY AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307-1713
Mailing Address - Country:US
Mailing Address - Phone:330-208-8948
Mailing Address - Fax:
Practice Address - Street 1:1000 LEROY AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-1713
Practice Address - Country:US
Practice Address - Phone:330-208-8948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No374U00000XNursing Service Related ProvidersHome Health Aide