Provider Demographics
NPI:1992333140
Name:KUUSISTO, KARIN NICOLE (DO)
Entity type:Individual
Prefix:
First Name:KARIN
Middle Name:NICOLE
Last Name:KUUSISTO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 BATES AVENUE
Mailing Address - Street 2:SUITE FC 1860
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2698
Mailing Address - Country:US
Mailing Address - Phone:832-824-3719
Mailing Address - Fax:
Practice Address - Street 1:TEXAS CHILDREN'S HOSPITAL THE WOODLANDS
Practice Address - Street 2:17580 I-45 S
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384
Practice Address - Country:US
Practice Address - Phone:936-267-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A20897208000000X
390200000X
TXU5444208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program