1912493230 NPI number — MRS. KASHAELYN LANIECA HOLLINS-HENDERSON FNP-C

Table of content: MRS. KASHAELYN LANIECA HOLLINS-HENDERSON FNP-C (NPI 1912493230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912493230 NPI number — MRS. KASHAELYN LANIECA HOLLINS-HENDERSON FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLINS-HENDERSON
Provider First Name:
KASHAELYN
Provider Middle Name:
LANIECA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-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:
1912493230
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
705 CAMELIA CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DESOTO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75115-1521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-280-0266
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3900 N TARRANT PKWY STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76244-5410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
682-333-1804
Provider Business Practice Location Address Fax Number:
682-223-1346
Provider Enumeration Date:
07/10/2018

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: 363LF0000X , with the licence number:  AP137971 , 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)





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