=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588540173
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRYSTLE RITTERHOUSE RDCS, SRT, RVT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2025
-----------------------------------------------------
Last Update Date | 08/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 923 SHANNON MEADOW TRL
-----------------------------------------------------
City | CEDAR PARK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78613-5001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-434-6789
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 923 SHANNON MEADOW TRL
-----------------------------------------------------
City | CEDAR PARK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78613-5001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-434-6789
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2471C1106X
-----------------------------------------------------
Taxonomy Name | Cardiac-Interventional Technology Radiologic Technologist
-----------------------------------------------------
License Number | 245476
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------