Provider Demographics
NPI:1952979809
Name:SHAWN, KRISTYANNA LYNETTE
Entity Type:Individual
Prefix:
First Name:KRISTYANNA
Middle Name:LYNETTE
Last Name:SHAWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 WYANDOTTE ST APT 51
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-6458
Mailing Address - Country:US
Mailing Address - Phone:323-714-9991
Mailing Address - Fax:
Practice Address - Street 1:2601 WYANDOTTE ST APT 51
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-6458
Practice Address - Country:US
Practice Address - Phone:323-714-9991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker