Provider Demographics
NPI:1487079075
Name:EMANUEL, KIRSTEN LAUREN (FNP-C)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:LAUREN
Last Name:EMANUEL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-2913
Mailing Address - Country:US
Mailing Address - Phone:936-525-2800
Mailing Address - Fax:
Practice Address - Street 1:701 E DAVIS ST STE A
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-3102
Practice Address - Country:US
Practice Address - Phone:936-525-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-19
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX804707363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily