Provider Demographics
NPI:1235750787
Name:BERNAL, TRISTA LEE
Entity Type:Individual
Prefix:
First Name:TRISTA
Middle Name:LEE
Last Name:BERNAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 COUNTY ROAD 472
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-1139
Mailing Address - Country:US
Mailing Address - Phone:325-203-8991
Mailing Address - Fax:
Practice Address - Street 1:151 COUNTY ROAD 472
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-1139
Practice Address - Country:US
Practice Address - Phone:325-203-8991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX345615164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse