Provider Demographics
NPI:1093296394
Name:KIRTIS, KRISTAL (RN)
Entity Type:Individual
Prefix:
First Name:KRISTAL
Middle Name:
Last Name:KIRTIS
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 1:13290 NOEL RD APT 265
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-5658
Mailing Address - Country:US
Mailing Address - Phone:201-304-8606
Mailing Address - Fax:
Practice Address - Street 1:13290 NOEL RD APT 265
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-5658
Practice Address - Country:US
Practice Address - Phone:201-304-8606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX948338163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse