Provider Demographics
NPI:1841250438
Name:BRANNON, KRISTEN DAWN (PAC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:DAWN
Last Name:BRANNON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:DAWN
Other - Last Name:KOKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:405 SALEM DR
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054
Mailing Address - Country:US
Mailing Address - Phone:817-427-5986
Mailing Address - Fax:
Practice Address - Street 1:3024 STATE HWY 121
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021
Practice Address - Country:US
Practice Address - Phone:817-494-5000
Practice Address - Fax:817-494-5001
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02835363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A3492Medicare ID - Type Unspecified
P80446Medicare UPIN