Provider Demographics
NPI:1194075499
Name:RICHARD, KRISTAL (MS)
Entity type:Individual
Prefix:
First Name:KRISTAL
Middle Name:
Last Name:RICHARD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CHILDRENS WAY
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3500
Mailing Address - Country:US
Mailing Address - Phone:479-750-0130
Mailing Address - Fax:479-750-0937
Practice Address - Street 1:519 LATHAM DR
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745-8360
Practice Address - Country:US
Practice Address - Phone:479-750-0130
Practice Address - Fax:479-750-0937
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist