Provider Demographics
NPI:1871333443
Name:GRANADOS, KRISTEN MEGAN (RN)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MEGAN
Last Name:GRANADOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5979 MCNAUGHTON
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-9257
Mailing Address - Country:US
Mailing Address - Phone:210-286-9254
Mailing Address - Fax:
Practice Address - Street 1:5979 MCNAUGHTON
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-9257
Practice Address - Country:US
Practice Address - Phone:210-286-9254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1010878163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse