Provider Demographics
NPI:1992336275
Name:GOOLSBY, KRISTI RENEA (LVN)
Entity type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:RENEA
Last Name:GOOLSBY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:RENEA
Other - Last Name:DENNARD-GOOLSBY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LVN
Mailing Address - Street 1:6722 POWELL LN
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-1440
Mailing Address - Country:US
Mailing Address - Phone:832-680-9432
Mailing Address - Fax:
Practice Address - Street 1:6722 POWELL LN
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-1440
Practice Address - Country:US
Practice Address - Phone:832-680-9432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX329237164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse