MEDICARE: KRISTEN ANN WALLS PHYSICIAN ASSISTANT

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	363A00000X	Physician Assistant	PA11087	TX
2	363A00000X	Physician Assistant		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609313139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN ANN WALLS PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	PO BOX 3409
Second Line	:
City	:	PFLUGERVILLE
State	:	TX
Zip	:	78691-3409
Country	:	US
Telephone Number	:	512-202-3830
Fax Number	:	512-354-1106

Provider Business Practice Location Address
First Line	:	5220 W UNIVERSITY DR STE 290
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-7429
Country	:	US
Telephone Number	:	469-678-8322
Fax Number	:	469-678-8311

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

Provider Enumeration Date	:	01/23/2017
Last Update Date	:	04/03/2025

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