Basic Information
Provider Information
NPI: 1144622333
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SOSA
FirstName: KRISTEN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: RN, FNP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 919 HIDDEN RDG
Address2:  
City: IRVING
State: TX
PostalCode: 750383813
CountryCode: US
TelephoneNumber: 4692822711
FaxNumber: 4692820996
Practice Location
Address1: 2510 E MAIN ST
Address2: SUITE 106
City: ALICE
State: TX
PostalCode: 783324187
CountryCode: US
TelephoneNumber: 3616618370
FaxNumber: 3616618375
Other Information
ProviderEnumerationDate: 09/19/2014
LastUpdateDate: 03/08/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAP126433TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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