Provider Demographics
NPI:1144518978
Name:SHOVE, KRYSTA LEE (LMP)
Entity type:Individual
Prefix:
First Name:KRYSTA
Middle Name:LEE
Last Name:SHOVE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 N 113TH ST
Mailing Address - Street 2:APT# 201
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8580
Mailing Address - Country:US
Mailing Address - Phone:206-430-8355
Mailing Address - Fax:
Practice Address - Street 1:16303 HWY 99
Practice Address - Street 2:SUITE 2B
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-1453
Practice Address - Country:US
Practice Address - Phone:425-242-4884
Practice Address - Fax:425-743-9409
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60214993174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist