MEDICARE: MS. KRISTINA JO MAYO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	632565	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	84498U	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023000734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTINA JO MAYO

Provider Business Mailing Address
First Line	:	509 DUNAWAY LN
Second Line	:
City	:	AZLE
State	:	TX
Zip	:	76020-3207
Country	:	US
Telephone Number	:	817-692-0714
Fax Number	:

Provider Business Practice Location Address
First Line	:	509 DUNAWAY LN
Second Line	:
City	:	AZLE
State	:	TX
Zip	:	76020-3207
Country	:	US
Telephone Number	:	817-692-0714
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	10/28/2013

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