Healthcare Provider Details

I. General information

NPI: 1588158042
Provider Name (Legal Business Name): KRISTEN VIANEY DALE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2675 S ABILENE ST STE 100
AURORA CO
80014-2363
US

IV. Provider business mailing address

3001 BEE CAVES RD STE 220
AUSTIN TX
78746-5590
US

V. Phone/Fax

Practice location:
  • Phone: 720-507-4779
  • Fax: 833-941-5047
Mailing address:
  • Phone: 512-777-2591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberAP137100
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP137100
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: