Provider Demographics
NPI:1871177261
Name:LILES, KRYSTIN NICOLE (RN)
Entity type:Individual
Prefix:
First Name:KRYSTIN
Middle Name:NICOLE
Last Name:LILES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 COLLINS RD
Mailing Address - Street 2:
Mailing Address - City:HALLSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75650-3545
Mailing Address - Country:US
Mailing Address - Phone:936-933-1691
Mailing Address - Fax:
Practice Address - Street 1:1103 COLLINS RD
Practice Address - Street 2:
Practice Address - City:HALLSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75650-3545
Practice Address - Country:US
Practice Address - Phone:936-933-1691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX945827163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse