Provider Demographics
NPI:1497350714
Name:CARLTON, KRISTY DALYNN
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:DALYNN
Last Name:CARLTON
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 1:822 S. SECOND
Mailing Address - Street 2:
Mailing Address - City:GORMAN
Mailing Address - State:TX
Mailing Address - Zip Code:76454
Mailing Address - Country:US
Mailing Address - Phone:254-488-2015
Mailing Address - Fax:
Practice Address - Street 1:822 S. SECOND
Practice Address - Street 2:
Practice Address - City:GORMAN
Practice Address - State:TX
Practice Address - Zip Code:76454
Practice Address - Country:US
Practice Address - Phone:254-488-2015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX315624164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse