Provider Demographics
NPI:1942461884
Name:NIETO, KIRSTEN GIBBS (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:GIBBS
Last Name:NIETO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KIRSTEN
Other - Middle Name:INGLEE
Other - Last Name:GIBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12017 PALISADES PKWY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78732-1243
Mailing Address - Country:US
Mailing Address - Phone:713-870-1465
Mailing Address - Fax:
Practice Address - Street 1:4900 MUELLER BLVD
Practice Address - Street 2:UT SOUTHWESTERN AUSTIN PEDIATRICS
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-3079
Practice Address - Country:US
Practice Address - Phone:888-323-7277
Practice Address - Fax:512-324-0786
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTMB N8049207R00000X
TXN8049208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX321953701Medicaid
TX321953701Medicaid