Provider Demographics
NPI:1053091868
Name:HYATT, KRISTYN MICHELLE (RN)
Entity type:Individual
Prefix:
First Name:KRISTYN
Middle Name:MICHELLE
Last Name:HYATT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14762 IRIS ST
Mailing Address - Street 2:
Mailing Address - City:ADELANTO
Mailing Address - State:CA
Mailing Address - Zip Code:92301-6090
Mailing Address - Country:US
Mailing Address - Phone:760-881-8816
Mailing Address - Fax:
Practice Address - Street 1:14762 IRIS ST
Practice Address - Street 2:
Practice Address - City:ADELANTO
Practice Address - State:CA
Practice Address - Zip Code:92301-6090
Practice Address - Country:US
Practice Address - Phone:760-881-8816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95114054163WN0002X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care