Healthcare Provider Details

I. General information

NPI: 1972642650
Provider Name (Legal Business Name): KRISTIN ADELE HESTDALEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 KIRMAN AVE STE 200
RENO NV
89502-1340
US

IV. Provider business mailing address

4126 TECHNOLOGY WAY SUITE 102
CARSON CITY NV
89706-2009
US

V. Phone/Fax

Practice location:
  • Phone: 286-277-5982
  • Fax: 775-982-5496
Mailing address:
  • Phone: 775-687-7573
  • Fax: 775-687-7544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number10215
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: