Healthcare Provider Details

I. General information

NPI: 1609313139
Provider Name (Legal Business Name): KRISTEN ANN WALLS PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN ANN VENHUIZEN

II. Dates (important events)

Enumeration Date: 01/23/2017
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5220 W UNIVERSITY DR STE 290
MCKINNEY TX
75071-7429
US

IV. Provider business mailing address

PO BOX 3409
PFLUGERVILLE TX
78691-3409
US

V. Phone/Fax

Practice location:
  • Phone: 469-678-8322
  • Fax: 469-678-8311
Mailing address:
  • Phone: 512-202-3830
  • Fax: 512-354-1106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA11087
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: