Healthcare Provider Details

I. General information

NPI: 1699597187
Provider Name (Legal Business Name): KRYSTAL HARROW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 HILL ST
HIGH POINT NC
27260-5602
US

IV. Provider business mailing address

514 HILL ST
HIGH POINT NC
27260
US

V. Phone/Fax

Practice location:
  • Phone: 929-338-8827
  • Fax:
Mailing address:
  • Phone: 929-338-8827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number2023-8828-01
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: