Provider Demographics
NPI:1508811274
Name:VALLERY, KRISTEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:M
Last Name:VALLERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 HOSPITAL PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-5935
Mailing Address - Country:US
Mailing Address - Phone:817-554-0830
Mailing Address - Fax:817-554-0831
Practice Address - Street 1:1615 HOSPITAL PKWY STE 100
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-5935
Practice Address - Country:US
Practice Address - Phone:817-554-0830
Practice Address - Fax:817-554-0831
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301086072207V00000X
TXL6847207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX304558501Medicaid
MI4751445Medicaid
TX304558502Medicaid
TX304558501Medicaid
MI4751445Medicaid
MIC36082087Medicare PIN
MII34910Medicare UPIN