Provider Demographics
NPI:1033675038
Name:KINNEY, KRISTEN (FNP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:KINNEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3977 COUNTY ROAD 457
Mailing Address - Street 2:
Mailing Address - City:THORNDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76577
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:753 E TRAVIS ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-2353
Practice Address - Country:US
Practice Address - Phone:979-968-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138897363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily