Provider Demographics
NPI:1487490793
Name:HATTON, KRYSTLE (EMT-P, CJT)
Entity type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:
Last Name:HATTON
Suffix:
Gender:F
Credentials:EMT-P, CJT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12424 LUSHER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63138-1456
Mailing Address - Country:US
Mailing Address - Phone:314-452-6163
Mailing Address - Fax:
Practice Address - Street 1:12424 LUSHER RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63138-1456
Practice Address - Country:US
Practice Address - Phone:314-452-6163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-05
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOP-22026146L00000X
IL060727328146L00000X
MO174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic