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General NPI Number Information
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NPI Number | 1992226716
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Entity Type | Individual
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Provider Name | KRYSTLE AYRES NP-C
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Gender | Female
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Dates
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Enumeration Date | 07/01/2017
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Last Update Date | 07/01/2017
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Provider Practice Location Address
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Address Line | 3662 W INA RD
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City | TUCSON
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State | AZ
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Zip | 85741-2269
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Country | US
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Telephone | 602-350-7380
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Fax |
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Provider Business Mailing Address
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Address Line | 751 W JUDI DR
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City | CASA GRANDE
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State | AZ
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Zip | 85122-6176
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Country | US
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Telephone | 602-350-7380
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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 | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP10214
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License Number State | AZ
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