Provider Demographics
NPI:1093339178
Name:BANNISTER, KRISTAN LEA (FNP-BC, PMHNP)
Entity type:Individual
Prefix:
First Name:KRISTAN
Middle Name:LEA
Last Name:BANNISTER
Suffix:
Gender:
Credentials:FNP-BC, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8929 VISCOUNT BLVD STE LL-B
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-5827
Mailing Address - Country:US
Mailing Address - Phone:915-344-7165
Mailing Address - Fax:
Practice Address - Street 1:8929 VISCOUNT BLVD STE LLB
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-5827
Practice Address - Country:US
Practice Address - Phone:915-202-4463
Practice Address - Fax:915-289-2104
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1009201363LF0000X, 363LP0808X, 363LF0000X
NM79859363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily