Provider Demographics
NPI:1861709016
Name:KRISKA, JENNIFER C (CPNP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:C
Last Name:KRISKA
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3716 ATRIUM DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-3517
Mailing Address - Country:US
Mailing Address - Phone:142-284-7843
Mailing Address - Fax:
Practice Address - Street 1:11550 LEGACY DR STE 420
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-1998
Practice Address - Country:US
Practice Address - Phone:972-731-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX645444363LP0200X
TXAP116273363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX311626101Medicaid