Provider Demographics
NPI:1316380702
Name:MYATT, CRYSTAL LEIGH (RN)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:LEIGH
Last Name:MYATT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:LEIGH
Other - Last Name:KELTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:WEED ARMY COMMUNITY HOSPITAL, BLDG 166
Mailing Address - Street 2:3RD AND INNER LOOP RD, BLDG 166, RM 414
Mailing Address - City:FORT IRWIN
Mailing Address - State:CA
Mailing Address - Zip Code:92310-5109
Mailing Address - Country:US
Mailing Address - Phone:760-380-5388
Mailing Address - Fax:760-380-2122
Practice Address - Street 1:WEED ARMY COMMUNITY HOSPITAL, BLDG 166
Practice Address - Street 2:3RD AND INNER LOOP RD, BLDG 166, RM 414
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310-5109
Practice Address - Country:US
Practice Address - Phone:760-380-5388
Practice Address - Fax:760-380-2122
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1107036163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse