Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist |
NPI | 1003364472 |
---|---|
Provider Name | Dr. Kristy Disabatino Mcraney |
First Address | Saint Louis, MO 63131-1824 |
Second Address | Hattiesburg, MS 39402-1673 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2016 |
Last Update Date | 25/03/2019 |