PEDIATRIC KARE KLINIC PLLC NPI 1609348580

NPI Information

NPI: 1609348580
Provider Name: PEDIATRIC KARE KLINIC PLLC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 45D2171050

Address:
104 E US HIGHWAY 80 STE 190
FORNEY, TX
ZIP 75126
Phone: (469) 602-5277
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PEDIATRIC KARE KLINIC PLLC is a primary care clinic center in Forney, TX. PEDIATRIC KARE KLINIC PLLC NPI is 1609348580. The provider is registered as an organization entity type.

The provider's business location address is:

104 E US HIGHWAY 80 STE 190
FORNEY, TX
ZIP 75126-615
Phone: (469) 602-5277
Fax: (469) 995-7898

The provider's authorized official is Deloris Renee Harwell .
The authorized official title is Pediatric Nurse Practitioner and has the following contact phone number (469) 602-5277.

The CLIA number assigned to this NPI record is 45D2171050 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/17/2018 and was last updated on 3/12/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	407416301	MEDICAID	TEXAS
2	407416302	OTHER	TEXAS	TEXAS HEALTH STEPS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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