Provider Demographics
NPI:1295860971
Name:BROWN, KRISTA (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1107
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:TX
Mailing Address - Zip Code:79084-1107
Mailing Address - Country:US
Mailing Address - Phone:806-396-5583
Mailing Address - Fax:806-366-2713
Practice Address - Street 1:1220 PURNELL ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:TX
Practice Address - Zip Code:79084-1107
Practice Address - Country:US
Practice Address - Phone:806-396-5583
Practice Address - Fax:806-366-2713
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02125363LF0000X
TXAP110343363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMZ2565OtherMEDICAID GROUP
TX111938002Medicaid
TX111938003Medicaid
NM742823514OtherTAX ID
NM800521089OtherMEDICARE GROUP