Provider Demographics
NPI:1053341974
Name:HART, KRISTIN LEIGH (PAC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LEIGH
Last Name:HART
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:LEIGH
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:8701 SHOAL CREEK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-6864
Mailing Address - Country:US
Mailing Address - Phone:512-334-1885
Mailing Address - Fax:512-334-1890
Practice Address - Street 1:301 SETON PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-8002
Practice Address - Country:US
Practice Address - Phone:512-334-1885
Practice Address - Fax:512-334-1890
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03818363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1060290OtherNCCPA CERTIFICATE