Provider Demographics
NPI:1346507241
Name:HAMMAC, KRYSTLE MICHELLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTLE
Middle Name:MICHELLE
Last Name:HAMMAC
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KRYSTLE
Other - Middle Name:MICHELLE
Other - Last Name:LANGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11027 HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:BREWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36426-6577
Mailing Address - Country:US
Mailing Address - Phone:251-363-1372
Mailing Address - Fax:
Practice Address - Street 1:11027 HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:BREWTON
Practice Address - State:AL
Practice Address - Zip Code:36426-6577
Practice Address - Country:US
Practice Address - Phone:251-363-1372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-124687163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health