Provider Demographics
NPI:1467131698
Name:ROSLOV, KRISTEN (NP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:ROSLOV
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 KILLDEER CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-5802
Mailing Address - Country:US
Mailing Address - Phone:479-431-9347
Mailing Address - Fax:
Practice Address - Street 1:1545 E SOUTHLAKE BLVD STE 140
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6464
Practice Address - Country:US
Practice Address - Phone:817-332-7867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1124376363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily