Provider Demographics
NPI:1275015562
Name:ANDERSON, KRISTA NICOLE (FNP)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:NICOLE
Last Name:ANDERSON
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 1:2901 E 29TH ST STE 123
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2691
Mailing Address - Country:US
Mailing Address - Phone:979-776-9400
Mailing Address - Fax:979-774-8903
Practice Address - Street 1:2901 E 29TH ST STE 123
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2691
Practice Address - Country:US
Practice Address - Phone:979-776-9400
Practice Address - Fax:979-774-8903
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-03
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX840699163WE0003X
TXAP138747363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily