Provider Demographics
NPI:1184846875
Name:JENNINGS, KRISTINE (RN, MSN, ACNP-BC)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:RN, MSN, ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12500 DALLAS PKWY FL 2
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-4231
Mailing Address - Country:US
Mailing Address - Phone:469-604-9150
Mailing Address - Fax:
Practice Address - Street 1:12500 DALLAS PKWY FL 2
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-4231
Practice Address - Country:US
Practice Address - Phone:460-604-9150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15969363LA2100X
TX118658363LF0000X
TXAP118658363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily