Provider Demographics
NPI:1740435452
Name:YEPA, KRISTYN N (RN, BSN)
Entity type:Individual
Prefix:MS
First Name:KRISTYN
Middle Name:N
Last Name:YEPA
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SHEEP SPRING WAY
Mailing Address - Street 2:
Mailing Address - City:JEMEZ PUEBLO
Mailing Address - State:NM
Mailing Address - Zip Code:87024
Mailing Address - Country:US
Mailing Address - Phone:575-834-7202
Mailing Address - Fax:575-834-7119
Practice Address - Street 1:110 SHEEP SPRINGS ROAD
Practice Address - Street 2:
Practice Address - City:JEMEZ PUEBLO
Practice Address - State:NM
Practice Address - Zip Code:87024
Practice Address - Country:US
Practice Address - Phone:575-834-7207
Practice Address - Fax:575-834-7119
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR57885163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health