{
"Npi": {
"NPI": "1093339178",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BANNISTER",
"FirstName": "KRISTAN",
"MiddleName": "LEA",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "FNP-BC, PMHNP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "8929 VISCOUNT BLVD STE LL-B",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "EL PASO",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "79925-5827",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "915-344-7165",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "8929 VISCOUNT BLVD STE LLB",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "EL PASO",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "79925-5827",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "915-202-4463",
"PracticeLocationAddressFaxNumber": "915-289-2104",
"EnumerationDate": "06/03/2020",
"LastUpdateDate": "03/17/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "1009201",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": "1009201",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}