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General NPI Number Information
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NPI Number | 1285606699
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Entity Type | Individual
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Provider Name | KRISTINA J. DEASON MD
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Gender | Female
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Dates
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Enumeration Date | 02/02/2006
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Last Update Date | 05/24/2018
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Provider Practice Location Address
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Address Line | 2001 W ROSEDALE ST
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City | FORT WORTH
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State | TX
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Zip | 76104
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Country | US
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Telephone | 817-877-4777
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Fax |
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Provider Business Mailing Address
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Address Line | 6225 N STATE HIGHWAY 161 STE 200
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City | IRVING
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State | TX
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Zip | 75038-2241
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Country | US
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Telephone | 214-687-0496
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | J4523
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License Number State | TX
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