1295860971 NPI number — MRS. KRISTA BROWN FNP-C

Table of content: MRS. KRISTA BROWN FNP-C (NPI 1295860971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295860971 NPI number — MRS. KRISTA BROWN FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
KRISTA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295860971
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1107
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STRATFORD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79084-1107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-396-5583
Provider Business Mailing Address Fax Number:
806-366-2713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1220 PURNELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STRATFORD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79084-1107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-396-5583
Provider Business Practice Location Address Fax Number:
806-366-2713
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  CNP-02125 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: AP110343 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Z2565 . This is a "MEDICAID GROUP" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 111938002 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 111938003 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 742823514 . This is a "TAX ID" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 800521089 . This is a "MEDICARE GROUP" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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