Healthcare Provider Details

I. General information

NPI: 1740435452
Provider Name (Legal Business Name): KRISTYN N YEPA R.N., B.S.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2008
Last Update Date: 11/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SHEEP SPRINGS ROAD
JEMEZ PUEBLO NM
87024
US

IV. Provider business mailing address

110 SHEEP SPRING WAY
JEMEZ PUEBLO NM
87024
US

V. Phone/Fax

Practice location:
  • Phone: 575-834-7207
  • Fax: 575-834-7119
Mailing address:
  • Phone: 575-834-7202
  • Fax: 575-834-7119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR57885
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: