Provider Demographics
NPI:1376425181
Name:BELTRAN, KRYSTAL ANN
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:ANN
Last Name:BELTRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:
Other - Last Name:BOULDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:KILLDEER
Mailing Address - State:ND
Mailing Address - Zip Code:58640-0547
Mailing Address - Country:US
Mailing Address - Phone:406-304-5492
Mailing Address - Fax:
Practice Address - Street 1:398 RAILROAD STREET SE
Practice Address - Street 2:
Practice Address - City:KILLDEER
Practice Address - State:ND
Practice Address - Zip Code:58640
Practice Address - Country:US
Practice Address - Phone:406-304-5492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant