Healthcare Provider Details

I. General information

NPI: 1588306252
Provider Name (Legal Business Name): KRISTINE ROVELO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 SNIDER PLZ STE 130
DALLAS TX
75205-5649
US

IV. Provider business mailing address

6901 SNIDER PLZ STE 130
DALLAS TX
75205-5649
US

V. Phone/Fax

Practice location:
  • Phone: 214-696-8033
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1068755
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: