Provider Demographics
NPI:1184266538
Name:HERZOG, KRISTEN NICOLE (MSN, APRN, CPNP-PC)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:NICOLE
Last Name:HERZOG
Suffix:
Gender:F
Credentials:MSN, APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1644 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-6451
Mailing Address - Country:US
Mailing Address - Phone:281-844-0294
Mailing Address - Fax:
Practice Address - Street 1:1644 W 13TH ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-6451
Practice Address - Country:US
Practice Address - Phone:281-844-0294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143543363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics