Healthcare Provider Details

I. General information

NPI: 1245092733
Provider Name (Legal Business Name): KRYSTLE MARGRET WILLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4625 MOUNTAIN LAKES BLVD
REDDING CA
96003-1450
US

IV. Provider business mailing address

4625 MOUNTAIN LAKES BLVD
REDDING CA
96003-1450
US

V. Phone/Fax

Practice location:
  • Phone: 530-246-7172
  • Fax:
Mailing address:
  • Phone: 530-246-7172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: