Provider Demographics
NPI:1366021941
Name:HAGEN, KRISTIN PATRICIA
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:PATRICIA
Last Name:HAGEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:PATRICIA
Other - Last Name:HAMRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, RD
Mailing Address - Street 1:728 SHADE TREE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-2415
Mailing Address - Country:US
Mailing Address - Phone:512-925-2729
Mailing Address - Fax:
Practice Address - Street 1:728 SHADE TREE DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-2415
Practice Address - Country:US
Practice Address - Phone:512-925-2729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX721426163W00000X
TXDT84208133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No163W00000XNursing Service ProvidersRegistered Nurse