Individual provider Active NPI

Kristina Leah Reardon, CRNP

  • Adult Health Nurse Practitioner
  • Fort Worth, TX
National Provider Identifier
1205079464
Registry record updated Feb 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
811965 Issued in TX
Practice address
800 5TH Ave Ste 500
Fort Worth, TX 76104-7304
Phone
(817) 250-4280
NPI assigned
Apr 16, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN567319 PA
Registered Nurse 163W00000X 811965 TX
Adult Health Nurse Practitioner 363LA2200X SP009505 PA
Adult Health Nurse Practitioner 363LA2200X 811965 TX Primary

Addresses

Primary practice location

800 5TH Ave Ste 500
Fort Worth, TX 76104-7304

Mailing address

800 5TH Ave Ste 500
Fort Worth, TX 76104-7304
Phone (817) 250-4280

Other identifiers 1

IdentifierTypeStateIssuer
316409704MedicaidTX

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kng178352@Direct.TexasHealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130508000213 TX Practitioner - Nurse Practitioner 0345487583 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Texas Health Physicians GroupGroup PAC ID 4385535954, 1,364 clinicians

Practice addresses (Care Compare)

800 5TH Ave
Suite 500
Fort Worth, TX 76104-7304
Phone (817) 250-4280

Hospital & facility affiliations

  • Texas Health Harris Methodist Fort Worth Hospital, Fort Worth, TX, CCN 450135

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN567319PAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Health Physicians Group CurrentSince Feb 11, 2013 Accepting new patients
Texas Health Physicians Group Current Accepting new patients
Texas Health Physicians Group CurrentSince Feb 11, 2013 Accepting new patients

Locations

1600 Hospital Pkwy
Bedford, TX 76022
Phone (817) 355-7803

4333 N Josey Ln
Ste 104
Carrollton, TX 75010
Phone (972) 394-4500

1325 Pennsylvania Ave
Ste 890
Ft Worth, TX 76104
Phone (817) 250-4280

800 5th Ave
Ste 500
Ft Worth, TX 76104
Phone (817) 250-4280

800 5th Ave
Ft Worth, TX 76104
Phone (214) 506-2660

341 Wheatfield Dr
Ste 100
Sunnyvale, TX 75182
Phone (972) 329-1996

Interoperability endpoints

  • Direct secure messaging: kng178352@direct.texashealth.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1239840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645401600000",
    "number": "1205079464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 5TH AVE STE 500",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761047304",
            "telephone_number": "817-250-4280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 5TH AVE STE 500",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761047304",
            "telephone_number": "817-250-4280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REARDON",
        "first_name": "KRISTINA",
        "middle_name": "LEAH",
        "name_prefix": "Ms.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-16",
        "last_updated": "2022-02-21",
        "certification_date": "2022-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "PA",
            "license": "RN567319",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TX",
            "license": "811965",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "PA",
            "license": "SP009505",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "TX",
            "license": "811965",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "316409704",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kng178352@Direct.TexasHealth.org",
            "affiliation": "N",
            "address_1": "800 5th Ave Ste 500",
            "city": "Fort Worth",
            "state": "TX",
            "country_code": "US",
            "postal_code": "761047304",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.