1609885144 NPI number — MRS. TONGULA P DUNIGAN-KINER M.S. CCC-SLP

Table of content: MRS. TONGULA P DUNIGAN-KINER M.S. CCC-SLP (NPI 1609885144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609885144 NPI number — MRS. TONGULA P DUNIGAN-KINER M.S. CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUNIGAN-KINER
Provider First Name:
TONGULA
Provider Middle Name:
P
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S. CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609885144
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3607 HIDDEN HOLLOW DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND PRAIRIE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76065-8520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-280-4857
Provider Business Mailing Address Fax Number:
469-672-6245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2363 HIGHWAY 287 N STE 207
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANSFIELD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76063-7587
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-280-4857
Provider Business Practice Location Address Fax Number:
469-672-6245
Provider Enumeration Date:
08/05/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  17240 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 005-343-102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 528487 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 10018743 . This is a "AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 20-2507714 . This is a "HUMANA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".