Healthcare Provider Details

I. General information

NPI: 1215581723
Provider Name (Legal Business Name): CRYSTAL KAY ERNST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13201 E MAPLE GROVE RD
MOUNT HOPE KS
67108-9008
US

IV. Provider business mailing address

727 N WACO AVE STE 165
WICHITA KS
67203-3987
US

V. Phone/Fax

Practice location:
  • Phone: 316-259-0801
  • Fax: 316-444-2217
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: