Provider Demographics
NPI:1205569472
Name:TAYLOR, KRISTYN SMITH
Entity type:Individual
Prefix:
First Name:KRISTYN
Middle Name:SMITH
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25099 TENN OAKS RD
Mailing Address - Street 2:
Mailing Address - City:HOCKLEY
Mailing Address - State:TX
Mailing Address - Zip Code:77447-6070
Mailing Address - Country:US
Mailing Address - Phone:713-392-4076
Mailing Address - Fax:
Practice Address - Street 1:25099 TENN OAKS RD
Practice Address - Street 2:
Practice Address - City:HOCKLEY
Practice Address - State:TX
Practice Address - Zip Code:77447-6070
Practice Address - Country:US
Practice Address - Phone:713-392-4076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAPRN1102198363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner