Provider Demographics
NPI:1114581378
Name:MICHNA, KRISTIN (FNP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:MICHNA
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 1:2120 ALLIE PAYNE RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77632-1000
Mailing Address - Country:US
Mailing Address - Phone:409-998-9333
Mailing Address - Fax:
Practice Address - Street 1:3411 SPURLOCK RD
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-6430
Practice Address - Country:US
Practice Address - Phone:409-722-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138058363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily