Provider Demographics
NPI:1013321686
Name:DILLON, KRISTIN LENI (NP-C)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LENI
Last Name:DILLON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 E MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4188
Mailing Address - Country:US
Mailing Address - Phone:361-664-4445
Mailing Address - Fax:361-664-4449
Practice Address - Street 1:2510 E MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4188
Practice Address - Country:US
Practice Address - Phone:361-664-4445
Practice Address - Fax:361-664-4449
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125755363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4087256-01Medicaid