MEDICARE: DR. KRISTINA JEANNE HERNANDEZ D.O.

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	207R00000X	Internal Medicine Physician	P2868	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801057112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTINA JEANNE HERNANDEZ D.O.

Provider Business Mailing Address
First Line	:	13737 NOEL RD STE 1600
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-1374
Country	:	US
Telephone Number	:	469-518-4823
Fax Number	:

Provider Business Practice Location Address
First Line	:	13737 NOEL RD STE 1600
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-1374
Country	:	US
Telephone Number	:	469-518-4823
Fax Number	:	469-518-4827

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

Provider Enumeration Date	:	06/19/2008
Last Update Date	:	11/01/2022

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