Healthcare Provider Details

I. General information

NPI: 1114671633
Provider Name (Legal Business Name): KIRSTEN L LOPEZ CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 S LOOP 336 W STE 110
CONROE TX
77304-3320
US

IV. Provider business mailing address

122 W JOHN CARPENTER FWY STE 420
IRVING TX
75039-2014
US

V. Phone/Fax

Practice location:
  • Phone: 936-539-8190
  • Fax:
Mailing address:
  • Phone: 972-957-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1069762
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: