Provider Demographics
NPI:1851532923
Name:HANCHETT, KRIS ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KRIS
Middle Name:ALAN
Last Name:HANCHETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 PUEBLO HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-6151
Mailing Address - Country:US
Mailing Address - Phone:702-210-4205
Mailing Address - Fax:702-633-6484
Practice Address - Street 1:1101 PUEBLO HILLS AVE
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-6151
Practice Address - Country:US
Practice Address - Phone:702-210-4205
Practice Address - Fax:702-633-6484
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-10334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIG82884Medicare UPIN