Provider Demographics
NPI:1104507821
Name:KRISTAS PSYCHIATRY
Entity type:Organization
Organization Name:KRISTAS PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ADEBOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSIKOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-807-5367
Mailing Address - Street 1:1516 ABERCORN LN
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-1600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1516 ABERCORN LN
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-1600
Practice Address - Country:US
Practice Address - Phone:832-807-5367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty