Doctor Name: | KRYSTIN DANIELLE NUTT |
NPI Number: | 1205162583 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP-C |
License Number: | R868171 |
Business Practice Address: | 321 Highway 13 S Morton, MS - 391173353 |
Business Phone Number: | 6017328612 |
Business Fax Number: | 6017321957 |
Mailing Address: | Po Box 2065, MERIDIAN |
State: | MS |
Postal Code: | 393022065 |
Phone Number: | 6017034282 |
Fax Number: | 6017034597 |
NPI Enumeration Date: | 10/21/2009 |
NPI Last Update Date: | 11/09/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R868171 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |