Individual
KRYSTAL CASTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
305 W RUSK ST, TYLER, TX 75701-1514
(903) 592-7304
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
M8577
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
194798801
—
TX
01
—
8BE141
BCBS
TX
01
—
TIN PLUS 004
TRICARE
TX
Enumeration date
04/25/2007
Last updated
03/15/2016
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