Healthcare Provider Details

I. General information

NPI: 1689494742
Provider Name (Legal Business Name): KRISTIN RENEE PATTERSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTIN RENEE CARMICAL APRN, CRNA

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E MARSHALL AVE
LONGVIEW TX
75601-5580
US

IV. Provider business mailing address

700 E MARSHALL AVE
LONGVIEW TX
75601-5580
US

V. Phone/Fax

Practice location:
  • Phone: 903-315-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1176537
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: