Provider Demographics
NPI:1144657404
Name:CISNEROS, CRYSTAL FAITH (NP)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:FAITH
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 OAK BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-5630
Mailing Address - Country:US
Mailing Address - Phone:512-417-8523
Mailing Address - Fax:
Practice Address - Street 1:101 CHRIS KELLEY BLVD
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-5540
Practice Address - Country:US
Practice Address - Phone:512-759-3980
Practice Address - Fax:512-276-6698
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX742176363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily