Provider Demographics
NPI:1316212210
Name:AGBAHIWE, KRYSTAL BOWMAN (CRNA)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:BOWMAN
Last Name:AGBAHIWE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6720 BERTNER AVE., SUITE O-520, MC1-226 , HARRIS COUNTY
Mailing Address - Street 2:ATTN: MARIE SANCHEZ
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:832-355-6279
Mailing Address - Fax:
Practice Address - Street 1:7200 CAMBRIDGE ST FL 10
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4202
Practice Address - Country:US
Practice Address - Phone:713-798-1750
Practice Address - Fax:713-798-4693
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX713027367500000X
TXAP121426367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX296754901Medicaid
TX8949UCOtherBCBS
TX296754902Medicaid
TXP01328218OtherRR MEDICARE
TX8949UCOtherBCBS