Provider Demographics
NPI:1609313139
Name:WALLS, KRISTEN ANN (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ANN
Last Name:WALLS
Suffix:
Gender:
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:ANN
Other - Last Name:VENHUIZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3409
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78691-3409
Mailing Address - Country:US
Mailing Address - Phone:512-202-3830
Mailing Address - Fax:512-354-1106
Practice Address - Street 1:5220 W UNIVERSITY DR STE 290
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-7429
Practice Address - Country:US
Practice Address - Phone:469-678-8322
Practice Address - Fax:469-678-8311
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA11087363A00000X
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX387287101Medicaid