Provider Demographics
NPI:1164548673
Name:CAMPBELL, KRISTIN CARTER (CPNP)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:CARTER
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:ELIZABETH
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6210 E HWY 290
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1142
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15801 W HWY 71 STE 100
Practice Address - Street 2:
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738-2703
Practice Address - Country:US
Practice Address - Phone:512-676-2500
Practice Address - Fax:512-406-7377
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2024-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRN867225363LP0200X, 363LP0200X
TXAP125831363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics