Provider Demographics
NPI:1396938593
Name:DR KRISTEN INNES
Entity type:Organization
Organization Name:DR KRISTEN INNES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:INNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-618-2802
Mailing Address - Street 1:3880 PARKWOOD BLVD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-1928
Mailing Address - Country:US
Mailing Address - Phone:214-618-2802
Mailing Address - Fax:214-618-3208
Practice Address - Street 1:3880 PARKWOOD BLVD
Practice Address - Street 2:SUITE 403
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1928
Practice Address - Country:US
Practice Address - Phone:214-618-2802
Practice Address - Fax:214-618-3208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2658261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty