Provider Demographics
NPI:1851659460
Name:PRYOR, TRISTA D (RN)
Entity Type:Individual
Prefix:MS
First Name:TRISTA
Middle Name:D
Last Name:PRYOR
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 1:701 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LAS ANIMAS
Mailing Address - State:CO
Mailing Address - Zip Code:81054-1575
Mailing Address - Country:US
Mailing Address - Phone:719-456-0517
Mailing Address - Fax:719-456-0518
Practice Address - Street 1:701 S PARK AVE
Practice Address - Street 2:
Practice Address - City:LAS ANIMAS
Practice Address - State:CO
Practice Address - Zip Code:81054-1575
Practice Address - Country:US
Practice Address - Phone:719-456-0517
Practice Address - Fax:719-456-0518
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN 197631163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO197631OtherRN LICENSE