Provider Demographics
NPI:1598066599
Name:HYLAN, KRISTI RAE (RN)
Entity Type:Individual
Prefix:MISS
First Name:KRISTI
Middle Name:RAE
Last Name:HYLAN
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 1:848 GLADSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-4202
Mailing Address - Country:US
Mailing Address - Phone:318-773-8793
Mailing Address - Fax:
Practice Address - Street 1:848 GLADSTONE BLVD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-4202
Practice Address - Country:US
Practice Address - Phone:318-773-8793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-06
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06351367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered