Provider Demographics
NPI:1861373714
Name:DOVE YOUTHOLOGY AESTHETIC INSTITUTE, PLLC
Entity type:Organization
Organization Name:DOVE YOUTHOLOGY AESTHETIC INSTITUTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO, NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRYSTLE
Authorized Official - Middle Name:HORNE
Authorized Official - Last Name:DOVE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:704-453-8232
Mailing Address - Street 1:218 S SWING RD STE 5
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27409-2051
Mailing Address - Country:US
Mailing Address - Phone:336-500-8699
Mailing Address - Fax:
Practice Address - Street 1:218 S SWING RD STE 5
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-2051
Practice Address - Country:US
Practice Address - Phone:336-500-8699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty