Provider Demographics
NPI:1902612146
Name:VALDES, KRISTAN R (APRN - PMHNP - BC,)
Entity type:Individual
Prefix:MR
First Name:KRISTAN
Middle Name:R
Last Name:VALDES
Suffix:
Gender:M
Credentials:APRN - PMHNP - BC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3802 KEYSTONE ST
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-5146
Mailing Address - Country:US
Mailing Address - Phone:214-790-6829
Mailing Address - Fax:
Practice Address - Street 1:6601 MONTANA AVE STE J
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-2143
Practice Address - Country:US
Practice Address - Phone:915-249-6227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1020722363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health