Healthcare Provider Details

I. General information

NPI: 1003092602
Provider Name (Legal Business Name): KRYSTAL GAIL STONE CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRYSTAL GAIL SAMPSON CSW

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 FREDERICA ST
OWENSBORO KY
42301
US

IV. Provider business mailing address

SUNRISE CHILDREN'S SERVICES PO BOX 1429
MT WASHINGTON KY
40047
US

V. Phone/Fax

Practice location:
  • Phone: 270-926-2484
  • Fax: 270-685-6015
Mailing address:
  • Phone: 502-538-1000
  • Fax: 502-538-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCSW6920
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: