Provider Demographics
NPI:1154915130
Name:WINDER, LACRYSTAL
Entity type:Individual
Prefix:
First Name:LACRYSTAL
Middle Name:
Last Name:WINDER
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 1:404 THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38703-6764
Mailing Address - Country:US
Mailing Address - Phone:662-436-1030
Mailing Address - Fax:
Practice Address - Street 1:404 THOMAS ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-6764
Practice Address - Country:US
Practice Address - Phone:662-436-1030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-21
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty