Provider Demographics
NPI:1326876947
Name:HART, KRYSTLE (RN)
Entity type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:
Last Name:HART
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 1:7168 S SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1741
Mailing Address - Country:US
Mailing Address - Phone:720-289-1656
Mailing Address - Fax:
Practice Address - Street 1:7168 S SPRUCE ST
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1741
Practice Address - Country:US
Practice Address - Phone:720-289-1656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility