Provider Demographics
NPI:1275175580
Name:HANNON, KRYSTEL LYNN (RN)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTEL
Middle Name:LYNN
Last Name:HANNON
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 1:899 CHAMPION FERRY RD
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29341-5613
Mailing Address - Country:US
Mailing Address - Phone:864-492-2004
Mailing Address - Fax:
Practice Address - Street 1:141 TWIN LAKE RD
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-2526
Practice Address - Country:US
Practice Address - Phone:864-206-2201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC223177163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse