Provider Demographics
NPI:1073133724
Name:KIENZL, TRYSTEN
Entity Type:Individual
Prefix:
First Name:TRYSTEN
Middle Name:
Last Name:KIENZL
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 1:11732 CRYSTAL BROOK LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-1664
Mailing Address - Country:US
Mailing Address - Phone:865-805-6133
Mailing Address - Fax:
Practice Address - Street 1:11732 CRYSTAL BROOK LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1664
Practice Address - Country:US
Practice Address - Phone:865-805-6133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279E0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredEmergency Care