Provider Demographics
NPI:1447960067
Name:WATERS, KRISTI LEE
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:LEE
Last Name:WATERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 713
Mailing Address - Street 2:
Mailing Address - City:VEGA
Mailing Address - State:TX
Mailing Address - Zip Code:79092-0713
Mailing Address - Country:US
Mailing Address - Phone:806-729-1931
Mailing Address - Fax:
Practice Address - Street 1:400 E 7TH
Practice Address - Street 2:
Practice Address - City:SUNRAY
Practice Address - State:TX
Practice Address - Zip Code:79086-1724
Practice Address - Country:US
Practice Address - Phone:806-948-1188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13176235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist