Provider Demographics
NPI:1578354049
Name:LOVELADY, KRISTIN N
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:N
Last Name:LOVELADY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:N
Other - Last Name:JENNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3625 TIERRA ALBA DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-4351
Mailing Address - Country:US
Mailing Address - Phone:915-731-3428
Mailing Address - Fax:
Practice Address - Street 1:11601 PELLICANO DR STE A3
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6054
Practice Address - Country:US
Practice Address - Phone:915-224-0056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT133160225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist