Provider Demographics
NPI:1740809706
Name:HANCOCK, KRISTIN (PA-C, RD, LD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:PA-C, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12850 TOEPPERWEIN RD
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-4115
Mailing Address - Country:US
Mailing Address - Phone:210-614-1234
Mailing Address - Fax:
Practice Address - Street 1:6098 FM 311
Practice Address - Street 2:
Practice Address - City:SPRING BRANCH
Practice Address - State:TX
Practice Address - Zip Code:78070-7253
Practice Address - Country:US
Practice Address - Phone:830-885-5541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-10
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA13652363A00000X
TXDT86139133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered