Provider Demographics
NPI:1952042541
Name:CARLTON, KRYSTILE
Entity Type:Individual
Prefix:
First Name:KRYSTILE
Middle Name:
Last Name:CARLTON
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 1:5216 E LAKE RD APT 1B
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44054-1732
Mailing Address - Country:US
Mailing Address - Phone:440-654-5718
Mailing Address - Fax:
Practice Address - Street 1:5216 E LAKE RD APT 1B
Practice Address - Street 2:
Practice Address - City:SHEFFIELD LAKE
Practice Address - State:OH
Practice Address - Zip Code:44054-1732
Practice Address - Country:US
Practice Address - Phone:440-654-5718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide