Provider Demographics
NPI:1801133921
Name:IRBY, KRYSTAL NICOLE
Entity type:Individual
Prefix:MS
First Name:KRYSTAL
Middle Name:NICOLE
Last Name:IRBY
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 1:1382 BUNTS RD
Mailing Address - Street 2:APT 4
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-2639
Mailing Address - Country:US
Mailing Address - Phone:216-903-7976
Mailing Address - Fax:
Practice Address - Street 1:1382 BUNTS RD
Practice Address - Street 2:APT 4
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4461
Practice Address - Country:US
Practice Address - Phone:216-903-7976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health