Healthcare Provider Details

I. General information

NPI: 1629467162
Provider Name (Legal Business Name): CHRISTIN MARIE MUDD AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2015
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 HARRY HINES BLVD
DALLAS TX
75390-7738
US

IV. Provider business mailing address

3805 DESERT WILLOW DR
DENTON TX
76208-7600
US

V. Phone/Fax

Practice location:
  • Phone: 214-645-8300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP127112
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: