Provider Demographics
NPI:1225338775
Name:KAMPRATH, KRISTIN ELIZABETH (MPAS PA-C)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:ELIZABETH
Last Name:KAMPRATH
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Gender:F
Credentials:MPAS PA-C
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Mailing Address - Street 1:900 JEROME ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3945
Mailing Address - Country:US
Mailing Address - Phone:817-720-9552
Mailing Address - Fax:817-921-1830
Practice Address - Street 1:900 JEROME ST
Practice Address - Street 2:SUITE 204
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3945
Practice Address - Country:US
Practice Address - Phone:817-720-9552
Practice Address - Fax:817-921-1830
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2022-02-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA06938363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX322060002Medicaid
TX322060001Medicaid
TX322060001Medicaid
TXTXB125251Medicare PIN
TXTXB125250Medicare PIN