MEDICARE: KRYSTE WHITEHEAD

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	225700000X	Massage Therapist	88373	AR

General Provider Information

NPI Number	:	1174113401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTE WHITEHEAD

Provider Business Mailing Address
First Line	:	5625 WILLOW WAY
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-2373
Country	:	US
Telephone Number	:	501-420-2848
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 MCCAIN BLVD STE B
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-8026
Country	:	US
Telephone Number	:	501-420-2848
Fax Number	:

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

Provider Enumeration Date	:	01/20/2021
Last Update Date	:	01/20/2021

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Directions to “ KRYSTE WHITEHEAD ” Practice Location

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