MEDICARE: KRISTEN RENEE OWEN NP-C

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	363LF0000X	Family Nurse Practitioner	1062199	TX

General Provider Information

NPI Number	:	1033793112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN RENEE OWEN NP-C

Provider Business Mailing Address
First Line	:	4251 SUNSET DR
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-5653
Country	:	US
Telephone Number	:	325-481-2226
Fax Number	:

Provider Business Practice Location Address
First Line	:	4251 SUNSET DR
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-5653
Country	:	US
Telephone Number	:	325-481-2226
Fax Number	:

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

Provider Enumeration Date	:	05/05/2021
Last Update Date	:	02/09/2022

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