Provider Demographics
NPI:1316373616
Name:ESTRADA, KRISTI LYNN (ACNP)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:LYNN
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:ACNP
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 1010
Mailing Address - Street 2:
Mailing Address - City:ROCKDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76567
Mailing Address - Country:US
Mailing Address - Phone:254-709-9189
Mailing Address - Fax:
Practice Address - Street 1:1700 BRAZOS
Practice Address - Street 2:
Practice Address - City:ROCKDALE
Practice Address - State:TX
Practice Address - Zip Code:76567
Practice Address - Country:US
Practice Address - Phone:254-709-9189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX752478363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care