Provider Demographics
NPI:1700415197
Name:TYSON, KRYSTALA MONET (RN)
Entity Type:Individual
Prefix:
First Name:KRYSTALA
Middle Name:MONET
Last Name:TYSON
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 1:6345 DUCK CREEK DR APT 2447
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-3665
Mailing Address - Country:US
Mailing Address - Phone:214-476-3130
Mailing Address - Fax:
Practice Address - Street 1:6345 DUCK CREEK DR APT 2447
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-3665
Practice Address - Country:US
Practice Address - Phone:214-476-3130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX893984163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty