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NPI Code Detail

MEDICARE: KIJANA CRISWELL RN

MEDICARE: KIJANA CRISWELL RN
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
1163W00000XRegistered Nurse1040835TX

General Provider Information

NPI Number : 1336077056
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIJANA CRISWELL RN
Provider Business Mailing Address
First Line : 717 PINEWOOD ST
Second Line :
City : DIBOLL
State : TX
Zip : 75941-2213
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 800 E DAWSON ST
Second Line :
City : TYLER
State : TX
Zip : 75701-2036
Country : US
Telephone Number : 903-606-8441
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2026
Last Update Date : 05/12/2026

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Directions to “ KIJANA CRISWELL RN” Practice Location

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