Healthcare Provider Details

I. General information

NPI: 1508367566
Provider Name (Legal Business Name): KRYSTLE CUYOS NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 FANNIN ST
BEAUMONT TX
77701-3801
US

IV. Provider business mailing address

3330 FANNIN ST
BEAUMONT TX
77701-3801
US

V. Phone/Fax

Practice location:
  • Phone: 409-782-9587
  • Fax:
Mailing address:
  • Phone: 409-782-9587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number225210
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: