Provider Demographics
NPI:1093339178
Name:BANNISTER, KRISTAN LEA (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:KRISTAN
Middle Name:LEA
Last Name:BANNISTER
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5521 PLAINVIEW DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-1231
Mailing Address - Country:US
Mailing Address - Phone:915-329-7726
Mailing Address - Fax:
Practice Address - Street 1:5521 PLAINVIEW DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-1231
Practice Address - Country:US
Practice Address - Phone:915-329-7726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1009201363LF0000X
TX721174163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse