MEDICARE: KRISTIN MARIE HANES PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1118040	TX

General Provider Information

NPI Number	:	1528758141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN MARIE HANES PMHNP-BC

Provider Business Mailing Address
First Line	:	2200 TRADERS RD STE 501
Second Line	:
City	:	GREENVILLE
State	:	TX
Zip	:	75402-8314
Country	:	US
Telephone Number	:	903-231-3151
Fax Number	:	903-418-3785

Provider Business Practice Location Address
First Line	:	2200 TRADERS RD STE 501
Second Line	:
City	:	GREENVILLE
State	:	TX
Zip	:	75402-8314
Country	:	US
Telephone Number	:	903-231-3151
Fax Number	:	903-418-3785

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

Provider Enumeration Date	:	05/08/2023
Last Update Date	:	04/09/2026

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