Provider Demographics
NPI:1619133816
Name:GUTIERREZ, KRISTINA D (PNP)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:D
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-3813
Mailing Address - Country:US
Mailing Address - Phone:512-638-0688
Mailing Address - Fax:
Practice Address - Street 1:17600 I-45
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384
Practice Address - Country:US
Practice Address - Phone:936-267-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1917363LP0200X
TXAP121416363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP121416OtherTX BOARD OF NURSING LICENSE NUMBER
AZ384825Medicaid