Provider Demographics
NPI:1326465766
Name:GARRISON, KRISTINA ANNETTE (CPNP-PC)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:ANNETTE
Last Name:GARRISON
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:MRS
Other - First Name:KRISTINA
Other - Middle Name:ANNETTE
Other - Last Name:DICKERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 MLK JR BLVD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-1152
Mailing Address - Country:US
Mailing Address - Phone:940-397-2609
Mailing Address - Fax:940-264-2857
Practice Address - Street 1:6435 S FM 549 STE 201
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:TX
Practice Address - Zip Code:75032-6225
Practice Address - Country:US
Practice Address - Phone:214-771-3712
Practice Address - Fax:214-771-3796
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141856363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics