Healthcare Provider Details

I. General information

NPI: 1740850072
Provider Name (Legal Business Name): KRYSTAL R DYER HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2404 N GRIMES SUITE 800
HOBBS NM
88240
US

IV. Provider business mailing address

2404 N GRIMES SUITE 800
HOBBS NM
88240
US

V. Phone/Fax

Practice location:
  • Phone: 575-392-0218
  • Fax:
Mailing address:
  • Phone: 575-392-0218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: