Provider Demographics
NPI:1740011956
Name:JANAK, KRISTY LYNN
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:LYNN
Last Name:JANAK
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 1:2000 HUGHES LANDING BLVD APT 635
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-4136
Mailing Address - Country:US
Mailing Address - Phone:979-332-2953
Mailing Address - Fax:
Practice Address - Street 1:12244 SERENITY ROSE DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-4167
Practice Address - Country:US
Practice Address - Phone:979-332-2953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No174400000XOther Service ProvidersSpecialist
No171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator
No374700000XNursing Service Related ProvidersTechnician