Provider Demographics
NPI:1306461876
Name:BINGHAM, KRISTA (APRN)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16145 HIGHWAY 105 W STE 600
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-6069
Mailing Address - Country:US
Mailing Address - Phone:936-463-8104
Mailing Address - Fax:
Practice Address - Street 1:610 N LOOP 336 E
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-1437
Practice Address - Country:US
Practice Address - Phone:281-742-1142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1006649363LP2300X
TXF06200776363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care