Individual
MARY CAROL KISTNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
1401 W PULASKI ST, FORT WORTH, TX 76104-2717
(682) 885-8012
(682) 885-8014
Mailing address
PO BOX 99213, FORT WORTH, TX 76199-0213
(682) 885-1860
(682) 885-1396
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
505410
TX
363LP0200X
Pediatric Nurse Practitioner
AP117015
TX
363LP2300X
Primary Care Nurse Practitioner
Primary
AP117015
TX
Other
Enumeration date
07/16/2008
Last updated
07/03/2024
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