Provider Demographics
NPI:1841444692
Name:BAGNELL, KRISTI BENGTSON (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:BENGTSON
Last Name:BAGNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 JUDSON RD STE D
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-4675
Mailing Address - Country:US
Mailing Address - Phone:903-212-6060
Mailing Address - Fax:903-212-4466
Practice Address - Street 1:2304 JUDSON RD STE D
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-4675
Practice Address - Country:US
Practice Address - Phone:903-212-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6155208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics