MEDICARE: KRISTIN HANCOCK PA-C, RD, LD

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	PA13652	TX
2	133V00000X	Registered Dietitian	DT86139	TX

General Provider Information

NPI Number	:	1740809706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN HANCOCK PA-C, RD, LD

Provider Business Mailing Address
First Line	:	12850 TOEPPERWEIN RD
Second Line	:
City	:	LIVE OAK
State	:	TX
Zip	:	78233-4115
Country	:	US
Telephone Number	:	210-614-1234
Fax Number	:

Provider Business Practice Location Address
First Line	:	6098 FM 311
Second Line	:
City	:	SPRING BRANCH
State	:	TX
Zip	:	78070-7253
Country	:	US
Telephone Number	:	830-885-5541
Fax Number	:

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

Provider Enumeration Date	:	04/10/2020
Last Update Date	:	03/20/2023

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