1982708137 NPI number — DR. KENNETH CARROLL KILLEN MD

Table of content: MS. MARCELLA K NAPOLI MA, LMHCA (NPI 1861760480)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982708137 NPI number — DR. KENNETH CARROLL KILLEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KILLEN
Provider First Name:
KENNETH
Provider Middle Name:
CARROLL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KILLEN
Provider Other First Name:
KENNETH
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1982708137
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10300 N CENTRAL EXPY STE 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75231-8600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-706-9944
Provider Business Mailing Address Fax Number:
214-706-9941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10300 N CENTRAL EXPY STE 250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75231-8600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-706-9944
Provider Business Practice Location Address Fax Number:
214-706-9941
Provider Enumeration Date:
09/11/2006

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: 207R00000X , with the licence number:  D6054 , 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: 8F9403 . This is a "MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8BM800 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".