Provider Demographics
NPI:1952121436
Name:KERULONE KISS, RENATA
Entity type:Individual
Prefix:
First Name:RENATA
Middle Name:
Last Name:KERULONE KISS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12001 CHARM CIR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-6801
Mailing Address - Country:US
Mailing Address - Phone:737-309-7851
Mailing Address - Fax:
Practice Address - Street 1:12001 CHARM CIR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727-6801
Practice Address - Country:US
Practice Address - Phone:737-309-7851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL-315297174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN