MEDICARE: KRYSTAL WHITE MHPP

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1245768530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTAL WHITE MHPP

Provider Business Mailing Address
First Line	:	703 CALVIN AVERY DR STE A
Second Line	:
City	:	WEST MEMPHIS
State	:	AR
Zip	:	72301-6538
Country	:	US
Telephone Number	:	870-732-1878
Fax Number	:

Provider Business Practice Location Address
First Line	:	1712 LINDAUER RD
Second Line	:
City	:	FORREST CITY
State	:	AR
Zip	:	72335-2523
Country	:	US
Telephone Number	:	870-633-0511
Fax Number	:	870-633-0564

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

Provider Enumeration Date	:	05/31/2017
Last Update Date	:	05/31/2017

Similar Medicare Providers

1376590331 — BAPTIST MEMORIAL HOMECARE FORREST CITY
Practice Location Address:

1712 LINDAUER RD
FORREST CITY, AR
72335-2523

Practice Phone: 870-261-0188
Practice Fax:

1306886320 — BAPTIST MEMORIAL HOSPICE
Practice Location Address:

1712 LINDAUER RD
FORREST CITY, AR
72335-2523

Practice Phone: 870-261-0188
Practice Fax:

1700251733 — DENISHIO MURRAY MHPP
Practice Location Address:

1718 LINDAUER RD
FORREST CITY, AR
72335-2523

Practice Phone: 870-633-0511
Practice Fax:

1407217359 — GWENDOYLN REID MHPP
Practice Location Address:

1718 LINDAUER RD
FORREST CITY, AR
72335-2523

Practice Phone: 870-633-0511
Practice Fax: 870-633-0564

1538523196 — KEITH MONTGOMERY MHPP
Practice Location Address:

1718 LINDAUER RD
FORREST CITY, AR
72335-2523

Practice Phone: 870-633-0511
Practice Fax:

1023565892 — KNOSURER COCHRAN MHPP
Practice Location Address:

1718 LINDAUER RD
FORREST CITY, AR
72335-2523

Practice Phone: 870-633-0511
Practice Fax: 870-633-0564

Directions to “ KRYSTAL WHITE MHPP” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.