Healthcare Provider Details

I. General information

NPI: 1609121078
Provider Name (Legal Business Name): KRISTIN ERNEST M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 FANNIN STREET
HOUSTON TX
77030
US

IV. Provider business mailing address

2 GREENWAY PLAZA SUITE 300
HOUSTON TX
77046
US

V. Phone/Fax

Practice location:
  • Phone: 832-824-1000
  • Fax:
Mailing address:
  • Phone: 832-828-3660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP4264
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberP4264
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License NumberP4264
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: