MEDICARE: KRISTEN EVA NOEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	952277	TX

General Provider Information

NPI Number	:	1265909378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN EVA NOEL

Provider Business Mailing Address
First Line	:	12441 BELLA VINEYARD DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76126-1503
Country	:	US
Telephone Number	:	832-285-2468
Fax Number	:

Provider Business Practice Location Address
First Line	:	12441 BELLA VINEYARD DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76126-1503
Country	:	US
Telephone Number	:	832-285-2468
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2018
Last Update Date	:	10/26/2018

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