MEDICARE: KRISTEN TYD DNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	248661	AZ

General Provider Information

NPI Number	:	1942806021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN TYD DNP-C

Provider Business Mailing Address
First Line	:	PO BOX 35380
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5380
Country	:	US
Telephone Number	:	702-579-3203
Fax Number	:

Provider Business Practice Location Address
First Line	:	9250 N 3RD ST STE 2030
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-2407
Country	:	US
Telephone Number	:	602-786-0200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2020
Last Update Date	:	11/07/2025

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Directions to “ KRISTEN TYD DNP-C” Practice Location

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