MEDICARE: KRYSTAL LAKAY FOXWORTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376G00000X	Nursing Home Administrator

General Provider Information

NPI Number	:	1073337390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTAL LAKAY FOXWORTH

Provider Business Mailing Address
First Line	:	8500 ARGYLE BUSINESS LOOP APT 1307
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-6712
Country	:	US
Telephone Number	:	904-441-1482
Fax Number	:

Provider Business Practice Location Address
First Line	:	8500 ARGYLE BUSINESS LOOP APT 1307
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-6712
Country	:	US
Telephone Number	:	904-441-1482
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2024
Last Update Date	:	11/13/2024

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Directions to “ KRYSTAL LAKAY FOXWORTH ” Practice Location

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