Healthcare Provider Details

I. General information

NPI: 1093318669
Provider Name (Legal Business Name): KRISTINA JEAN PRATER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 HUDSPETH ST
SONORA TX
76950-8003
US

IV. Provider business mailing address

PO BOX 455
SONORA TX
76950-0455
US

V. Phone/Fax

Practice location:
  • Phone: 325-387-2521
  • Fax: 325-387-2396
Mailing address:
  • Phone: 325-387-2521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1019613
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: