Provider Demographics
NPI:1932585650
Name:WASHINGTON, KRYSTAL
Entity Type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:
Last Name:WASHINGTON
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 1:319 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:NEW MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:45346-9775
Mailing Address - Country:US
Mailing Address - Phone:937-459-8350
Mailing Address - Fax:
Practice Address - Street 1:319 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:NEW MADISON
Practice Address - State:OH
Practice Address - Zip Code:45346-9775
Practice Address - Country:US
Practice Address - Phone:937-459-8350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2020-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006999364S00000X
OHCOA.16742-NS364SA2200X
IN71006999A364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist