Provider Demographics
NPI:1831405893
Name:MCAULIFFE, KRISTINA D (MD)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:D
Last Name:MCAULIFFE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:D
Other - Last Name:EATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:800 W 4TH ST STE 2C60
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79763-4362
Mailing Address - Country:US
Mailing Address - Phone:432-703-5050
Mailing Address - Fax:432-335-5240
Practice Address - Street 1:301 N N ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6404
Practice Address - Country:US
Practice Address - Phone:432-620-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK8046207V00000X
TXT6641207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1615617Medicaid