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Individual
KRISTYN-MAE RUSSO ROSALES
Active
Individual
KRISTYN-MAE RUSSO ROSALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, FNP
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP136639
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
393519901
—
TX
01
—
393519902
MEDICAID-CSHCN
TX
01
—
8KL761
BCBS
TX
Enumeration date
10/17/2018
Last updated
04/03/2024
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