Provider Demographics
NPI:1942981121
Name:HAMILTON, TRISTYN LILY-ANN
Entity Type:Individual
Prefix:
First Name:TRISTYN
Middle Name:LILY-ANN
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRISTYN
Other - Middle Name:LILY-ANN
Other - Last Name:FULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2735 NEVADA AVE
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:IA
Mailing Address - Zip Code:50548-8850
Mailing Address - Country:US
Mailing Address - Phone:515-890-3570
Mailing Address - Fax:
Practice Address - Street 1:142 N 9TH ST
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-3911
Practice Address - Country:US
Practice Address - Phone:515-293-5620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician