Provider Demographics
NPI:1124505946
Name:ATKINSON, KIERSTIN DEZIREE (LVN)
Entity type:Individual
Prefix:
First Name:KIERSTIN
Middle Name:DEZIREE
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 ALEXIA
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-3008
Mailing Address - Country:US
Mailing Address - Phone:956-579-1588
Mailing Address - Fax:
Practice Address - Street 1:185 ALEXIA
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-3008
Practice Address - Country:US
Practice Address - Phone:956-579-1588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX340150164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1790847531Medicaid