MEDICARE: KRISTIN L AULT DO

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	207Q00000X	Family Medicine Physician	BP10021679	TX

General Provider Information

NPI Number	:	1609078211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN L AULT DO

Provider Business Mailing Address
First Line	:	2116 E RUSK ST
Second Line	:
City	:	JACKSONVILLE
State	:	TX
Zip	:	75766-9052
Country	:	US
Telephone Number	:	903-284-6105
Fax Number	:	903-284-6140

Provider Business Practice Location Address
First Line	:	2116 E RUSK ST
Second Line	:
City	:	JACKSONVILLE
State	:	TX
Zip	:	75766-9052
Country	:	US
Telephone Number	:	903-284-6105
Fax Number	:	903-284-6140

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

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	03/07/2012

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