Healthcare Provider Details

I. General information

NPI: 1982183414
Provider Name (Legal Business Name): KRISTEN NICOLE CEDILLO BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7721 HAWTHORN
TEMPLE TX
76502-5513
US

IV. Provider business mailing address

7721 HAWTHORN
TEMPLE TX
76502-5513
US

V. Phone/Fax

Practice location:
  • Phone: 254-654-1361
  • Fax:
Mailing address:
  • Phone: 254-654-1361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number922399
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number922399
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: