MEDICARE: KRISTI LEN NIELO

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	AP136596	TX

General Provider Information

NPI Number	:	1538669817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTI LEN NIELO

Provider Business Mailing Address
First Line	:	21820 KINGSLAND BLVD STE 101A
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-2507
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21820 KINGSLAND BLVD STE 101A
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-2507
Country	:	US
Telephone Number	:	832-321-5402
Fax Number	:	832-321-5407

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

Provider Enumeration Date	:	02/13/2018
Last Update Date	:	06/29/2019

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Directions to “ KRISTI LEN NIELO ” Practice Location

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