Provider Demographics
NPI:1699147199
Name:WENDT, KRISTIE MICHELE (CSA)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:MICHELE
Last Name:WENDT
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1110 JIB BOOM CT
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:TX
Mailing Address - Zip Code:77532-4032
Mailing Address - Country:US
Mailing Address - Phone:936-207-6636
Mailing Address - Fax:
Practice Address - Street 1:2911 SYCAMORE SPRINGS DR APT 410
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-1396
Practice Address - Country:US
Practice Address - Phone:936-520-0035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-22
Last Update Date:2023-09-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical