1225338775 NPI number — MS. KRISTIN ELIZABETH KAMPRATH MPAS PA-C

Table of content: MS. KRISTIN ELIZABETH KAMPRATH MPAS PA-C (NPI 1225338775)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225338775 NPI number — MS. KRISTIN ELIZABETH KAMPRATH MPAS PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAMPRATH
Provider First Name:
KRISTIN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MPAS PA-C
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:
1225338775
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 JEROME ST
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76104-3945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-720-9552
Provider Business Mailing Address Fax Number:
817-921-1830

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 JEROME ST
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76104-3945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-720-9552
Provider Business Practice Location Address Fax Number:
817-921-1830
Provider Enumeration Date:
11/01/2010

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: 363A00000X , with the licence number:  PA06938 , 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: 322060002 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 322060001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com