Provider Demographics
NPI:1215532684
Name:STARR, KRYSTA MARIE (RN)
Entity type:Individual
Prefix:
First Name:KRYSTA
Middle Name:MARIE
Last Name:STARR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48502-1015
Mailing Address - Country:US
Mailing Address - Phone:810-577-2893
Mailing Address - Fax:810-820-8987
Practice Address - Street 1:1202 CHURCH ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48502-1015
Practice Address - Country:US
Practice Address - Phone:810-577-2893
Practice Address - Fax:810-820-8987
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness