Provider Demographics
NPI:1609960343
Name:CARROLL, KRISTY DAWN (FNP)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:DAWN
Last Name:CARROLL
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 IH 45 S STE 300
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-4223
Mailing Address - Country:US
Mailing Address - Phone:936-294-0152
Mailing Address - Fax:832-559-8584
Practice Address - Street 1:179 IH 45 S STE 300
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4223
Practice Address - Country:US
Practice Address - Phone:936-294-0152
Practice Address - Fax:832-559-8584
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX665834363L00000X
TXAP114747363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J4760Medicare PIN