Provider Demographics
NPI:1467611293
Name:HUSTAK, KRISTI LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:LYNN
Last Name:HUSTAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTI
Other - Middle Name:LYNN
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12727 KIMBERLEY LN
Mailing Address - Street 2:SUITE 303
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-4047
Mailing Address - Country:US
Mailing Address - Phone:713-799-9999
Mailing Address - Fax:
Practice Address - Street 1:12727 KIMBERLEY LN
Practice Address - Street 2:SUITE 303
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-4047
Practice Address - Country:US
Practice Address - Phone:713-799-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP98782086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery