Healthcare Provider Details

I. General information

NPI: 1962134759
Provider Name (Legal Business Name): KRISTOPHER HIATT APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 S 200 W
BLANDING UT
84511-3922
US

IV. Provider business mailing address

735 S 200 W
BLANDING UT
84511-3922
US

V. Phone/Fax

Practice location:
  • Phone: 435-678-2254
  • Fax:
Mailing address:
  • Phone: 435-678-2254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10205647-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: