Provider Demographics
NPI:1366135485
Name:CROSS, KRISTY LYNN (RRT)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:LYNN
Last Name:CROSS
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:LYNN
Other - Last Name:SIPES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RRT
Mailing Address - Street 1:7107 N WAYNE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-2172
Mailing Address - Country:US
Mailing Address - Phone:734-728-5660
Mailing Address - Fax:
Practice Address - Street 1:4585 GROVE AVE
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-6619
Practice Address - Country:US
Practice Address - Phone:517-214-8386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI44010000112279P1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279P1005XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Rehabilitation