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General NPI Number Information
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NPI Number | 1093339178
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Entity Type | Individual
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Provider Name | KRISTAN LEA BANNISTER FNP-BC, PMHNP
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Gender | Female
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Dates
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Enumeration Date | 06/03/2020
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 8929 VISCOUNT BLVD STE LLB
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City | EL PASO
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State | TX
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Zip | 79925-5827
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Country | US
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Telephone | 915-202-4463
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Fax | 915-289-2104
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Provider Business Mailing Address
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Address Line | 8929 VISCOUNT BLVD STE LL-B
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City | EL PASO
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State | TX
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Zip | 79925-5827
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Country | US
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Telephone | 915-344-7165
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1009201
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1009201
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License Number State | TX
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