Provider Demographics
NPI:1245599638
Name:PICKERING, KRISTEN KAY (MD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:KAY
Last Name:PICKERING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:KAY
Other - Last Name:WILBANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1401 MEDICAL PKWY
Mailing Address - Street 2:BLDG B STE 100
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7763
Mailing Address - Country:US
Mailing Address - Phone:512-259-0900
Mailing Address - Fax:512-259-0949
Practice Address - Street 1:1401 MEDICAL PKWY
Practice Address - Street 2:BLDG B STE 100
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7763
Practice Address - Country:US
Practice Address - Phone:512-259-0900
Practice Address - Fax:512-259-0949
Is Sole Proprietor?:No
Enumeration Date:2012-05-07
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1-0042822208000000X
TXQ2051208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics