Basic Information
| Provider Information | |||||||||
| NPI: | 1669636551 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEBSTER | ||||||||
| FirstName: | KRIS | ||||||||
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| Credential: | HIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 230 N 1680 E | ||||||||
| Address2: | R3 | ||||||||
| City: | ST GEORGE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847902579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356734499 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 230 N 1680 E | ||||||||
| Address2: | R3 | ||||||||
| City: | ST GEORGE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847902579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356734499 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2008 | ||||||||
| LastUpdateDate: | 07/10/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 64413824602 | UT | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.