Healthcare Provider Details

I. General information

NPI: 1417608282
Provider Name (Legal Business Name): KRISTINE ANN PIKE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 W I 20 STE 120
ARLINGTON TX
76017-5871
US

IV. Provider business mailing address

811 W I 20 STE 120
ARLINGTON TX
76017-5871
US

V. Phone/Fax

Practice location:
  • Phone: 817-468-3393
  • Fax: 817-468-8734
Mailing address:
  • Phone: 817-468-3393
  • Fax: 817-468-8734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number841270
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1068308
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: