Provider Demographics
NPI:1538669817
Name:NIELO, KRISTI LEN
Entity Type:Individual
Prefix:
First Name:KRISTI LEN
Middle Name:
Last Name:NIELO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21820 KINGSLAND BLVD STE 101A
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21820 KINGSLAND BLVD STE 101A
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2507
Practice Address - Country:US
Practice Address - Phone:832-321-5402
Practice Address - Fax:832-321-5407
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2019-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136596363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily