Healthcare Provider Details

I. General information

NPI: 1326465766
Provider Name (Legal Business Name): KRISTINA ANNETTE GARRISON CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. KRISTINA ANNETTE DICKERSON

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6435 S FM 549 STE 201
HEATH TX
75032-6225
US

IV. Provider business mailing address

200 MLK JR BLVD
WICHITA FALLS TX
76301-1152
US

V. Phone/Fax

Practice location:
  • Phone: 214-771-3712
  • Fax: 214-771-3796
Mailing address:
  • Phone: 940-397-2609
  • Fax: 940-264-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP141856
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: