Healthcare Provider Details

I. General information

NPI: 1669189866
Provider Name (Legal Business Name): KHRISSYS KNOTTY XTENSIONS, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2022
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14474 SW 297TH TER
HOMESTEAD FL
33033-3953
US

IV. Provider business mailing address

14474 SW 297TH TER
HOMESTEAD FL
33033-3953
US

V. Phone/Fax

Practice location:
  • Phone: 305-216-5940
  • Fax:
Mailing address:
  • Phone: 305-216-5940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL CARTER
Title or Position: PRESIDENT, CEO
Credential:
Phone: 305-216-5940