Provider Demographics
NPI:1669979365
Name:STEVENSON, KRISTEN (DO)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4925 GOLDEN TRIANGLE BOULEVARD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76244
Mailing Address - Country:US
Mailing Address - Phone:817-741-7353
Mailing Address - Fax:
Practice Address - Street 1:4925 GOLDEN TRIANGLE BOULEVARD
Practice Address - Street 2:SUITE 311
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76244
Practice Address - Country:US
Practice Address - Phone:817-741-7353
Practice Address - Fax:817-741-7501
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXS8921207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program