MEDICARE: KRYSTAL KIMISHA CHRISTOPHER PHD

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	103G00000X	Clinical Neuropsychologist	39798	TX
2	103T00000X	Psychologist	39798	TX

General Provider Information

NPI Number	:	1255279600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTAL KIMISHA CHRISTOPHER PHD

Provider Business Mailing Address
First Line	:	7000 FANNIN ST STE 1910
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-5400
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7000 FANNIN ST STE 1910
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-5400
Country	:	US
Telephone Number	:	713-500-8300
Fax Number	:

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

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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