1609313139 NPI number — KRISTEN ANN WALLS PHYSICIAN ASSISTANT

Table of content: DR. ACHAL PATEL M.D. (NPI 1306282389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609313139 NPI number — KRISTEN ANN WALLS PHYSICIAN ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALLS
Provider First Name:
KRISTEN
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHYSICIAN ASSISTANT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VENHUIZEN
Provider Other First Name:
KRISTEN
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609313139
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3409
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PFLUGERVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78691-3409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-202-3830
Provider Business Mailing Address Fax Number:
512-354-1106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5220 W UNIVERSITY DR STE 290
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCKINNEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75071-7429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-678-8322
Provider Business Practice Location Address Fax Number:
469-678-8311
Provider Enumeration Date:
01/23/2017

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: 363A00000X , with the licence number:  PA11087 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 387287101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".