Provider Demographics
NPI:1245700665
Name:UTT, MISTI NICOLE (RN)
Entity type:Individual
Prefix:
First Name:MISTI
Middle Name:NICOLE
Last Name:UTT
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 1:4414 RUNNING PINE DR
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-4749
Mailing Address - Country:US
Mailing Address - Phone:304-517-7009
Mailing Address - Fax:
Practice Address - Street 1:4414 RUNNING PINE DR
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-4749
Practice Address - Country:US
Practice Address - Phone:304-517-7009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV76277163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics