MS. KRISTINA LEAH REARDON CRNP NPI 1205079464

NPI Information

NPI: 1205079464
Provider Name: MS. KRISTINA LEAH REARDON, CRNP
Classification: Nurse Practitioner - 363LA2200X
Entity Type: Individual

Specialization: Adult Health

PECOS Registration: Yes

Address:
800 5TH AVE STE 500
FORT WORTH, TX
ZIP 76104
Phone: (817) 250-4280
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MS. Kristina Leah Reardon, CRNP is an adult health nurse practitioner in Fort Worth, TX with 17 years of experience. MS. Kristina Leah Reardon, CRNP NPI is 1205079464. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

800 5TH AVE STE 500
FORT WORTH, TX
ZIP 76104-304
Phone: (817) 250-4280

The NPI 1205079464 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 4/16/2009 and was last updated on 2/21/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	163W00000X	Registered Nurse		RN567319	PENNSYLVANIA	No
2	163W00000X	Registered Nurse		811965	TEXAS	No
3	363LA2200X	Nurse Practitioner	Adult Health	SP009505	PENNSYLVANIA	No
4	363LA2200X	Nurse Practitioner	Adult Health	811965	TEXAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	316409704	MEDICAID	TEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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