MEDICARE: KIRSTEN ANGELIQUE WADE PNP

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	363LP0200X	Pediatric Nurse Practitioner	AP122926	TX

General Provider Information

NPI Number	:	1891711552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTEN ANGELIQUE WADE PNP

Provider Business Mailing Address
First Line	:	803 SIERRA AVE
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-1887
Country	:	US
Telephone Number	:	972-249-5561
Fax Number	:

Provider Business Practice Location Address
First Line	:	6109 S COOPER ST
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76001-5814
Country	:	US
Telephone Number	:	866-492-5008
Fax Number	:

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	01/29/2025

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