Provider Demographics
NPI:1407338171
Name:KISNER, PETER (RN)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:KISNER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 CHISHOLM TRL
Mailing Address - Street 2:
Mailing Address - City:SALADO
Mailing Address - State:TX
Mailing Address - Zip Code:76571-5451
Mailing Address - Country:US
Mailing Address - Phone:254-217-7046
Mailing Address - Fax:
Practice Address - Street 1:835 TUSCAN RD
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-8694
Practice Address - Country:US
Practice Address - Phone:877-773-2563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX803440163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health