Individual
MS. KRISTINA LEAH REARDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
800 5TH AVE STE 500, FORT WORTH, TX 76104-7304
(817) 250-4280
Mailing address
800 5TH AVE STE 500, FORT WORTH, TX 76104-7304
(817) 250-4280
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
811965
TX
163W00000X
Registered Nurse
RN567319
PA
363LA2200X
Adult Health Nurse Practitioner
Primary
811965
TX
363LA2200X
Adult Health Nurse Practitioner
SP009505
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
316409704
—
TX
Enumeration date
04/16/2009
Last updated
02/21/2022
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