Provider Demographics
NPI:1053892687
Name:BEATY, KRISTIE C
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:C
Last Name:BEATY
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 1:7218 SAVANNAH GLEN LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-7351
Mailing Address - Country:US
Mailing Address - Phone:904-240-8516
Mailing Address - Fax:
Practice Address - Street 1:16431 LEXINGTON BLVD
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2308
Practice Address - Country:US
Practice Address - Phone:904-240-8516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107630235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist