MEDICARE: KRYSTIN WHITE

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	235Z00000X	Speech-Language Pathologist	115804	TX

General Provider Information

NPI Number	:	1932883824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTIN WHITE

Provider Business Mailing Address
First Line	:	3191 MEDICAL CENTER DR APT 3105
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75069-1662
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6841 VIRGINIA PKWY STE 103-134
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-5710
Country	:	US
Telephone Number	:	214-755-7504
Fax Number	:

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

Provider Enumeration Date	:	06/12/2023
Last Update Date	:	06/12/2023

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Directions to “ KRYSTIN WHITE ” Practice Location

Language	Start Address	Practice Location

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