Healthcare Provider Details

I. General information

NPI: 1992038400
Provider Name (Legal Business Name): KRISTEN L STEGEMOLLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 04/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N BROWN ST
HAMILTON TX
76531-1515
US

IV. Provider business mailing address

PO BOX 633
HAMILTON TX
76531-0633
US

V. Phone/Fax

Practice location:
  • Phone: 254-386-1700
  • Fax: 254-386-4950
Mailing address:
  • Phone: 254-386-1700
  • Fax: 254-386-4950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP1413
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: