Provider Demographics
NPI:1134966484
Name:HANSEN, KIELY KRISTINE (APRN, CPNP-PC)
Entity type:Individual
Prefix:MRS
First Name:KIELY
Middle Name:KRISTINE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:6310 MESA GRANDE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-4027
Mailing Address - Country:US
Mailing Address - Phone:925-389-1090
Mailing Address - Fax:
Practice Address - Street 1:7004 BEE CAVES ROAD
Practice Address - Street 2:BUILDING 1, SUITE 210
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5004
Practice Address - Country:US
Practice Address - Phone:512-327-0562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1003298363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics