Provider Demographics
NPI:1336338565
Name:PARSONS, KRISTINA SIMIC (NP)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:SIMIC
Last Name:PARSONS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:SIMIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1617 HEMPHILL ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4709
Mailing Address - Country:US
Mailing Address - Phone:817-702-3367
Mailing Address - Fax:817-927-3603
Practice Address - Street 1:900 W MAGNOLIA AVE
Practice Address - Street 2:STE. 100
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-8517
Practice Address - Country:US
Practice Address - Phone:817-870-7300
Practice Address - Fax:817-332-8372
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX632651363LF0000X
TXAP115286363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX451729YKPWMedicare PIN