Healthcare Provider Details

I. General information

NPI: 1184407165
Provider Name (Legal Business Name): KRISTI RENE DODSON-CONNER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTI RENE DODSON FNP-BC

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4002 BURKE RD # 100
PASADENA TX
77504-3451
US

IV. Provider business mailing address

6300 SEAWALL BLVD # 9201
GALVESTON TX
77551-2219
US

V. Phone/Fax

Practice location:
  • Phone: 281-741-2982
  • Fax:
Mailing address:
  • Phone: 254-248-4185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1135857
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number984604
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: