Healthcare Provider Details

I. General information

NPI: 1265779649
Provider Name (Legal Business Name): KRISTY D. FOX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2013
Last Update Date: 01/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 MERCER RD
GREENVILLE PA
16125-8416
US

IV. Provider business mailing address

16 ROONEY ST
GREENVILLE PA
16125-2453
US

V. Phone/Fax

Practice location:
  • Phone: 724-498-4276
  • Fax: 724-498-4876
Mailing address:
  • Phone: 724-498-4276
  • Fax: 724-498-4876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTY D. FOX
Title or Position: DIRECTOR
Credential: CH, CLC, RM
Phone: 724-498-4276