Provider Demographics
NPI:1275126138
Name:HILL, KRISTINA WATERS
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:WATERS
Last Name:HILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:K
Other - Last Name:WATERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1475 N MAIN ST APT H303
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-2397
Mailing Address - Country:US
Mailing Address - Phone:801-564-9166
Mailing Address - Fax:
Practice Address - Street 1:1475 N MAIN ST APT H303
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-2397
Practice Address - Country:US
Practice Address - Phone:801-564-9166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
UT106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician