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General NPI Number Information
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NPI Number | 1700150398
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Entity Type | Individual
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Provider Name | KAYLYNN KRIS ATENE RRT
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Gender | Female
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Dates
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Enumeration Date | 02/29/2012
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Last Update Date | 05/25/2021
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Provider Practice Location Address
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Address Line | 167 NORTH MAIN STREET
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City | TUBA CITY
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State | AZ
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Zip | 86045-0600
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Country | US
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Telephone | 928-283-2501
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Fax |
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Provider Business Mailing Address
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Address Line | 516 E NIZHONI BLVD
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City | GALLUP
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State | NM
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Zip | 87301-5748
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Country | US
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Telephone | 505-722-1000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | CNA1000032322
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 227900000X
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Taxonomy Name | Registered Respiratory Therapist
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License Number | 012248
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License Number State | AZ
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