| Organization Name: | PEDIATRIC HEALTH PARTNERS PLLC |
| NPI Number: | 1023364049 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KIMBERLY BOOKOUT (OWNER) |
| Mailing Address: | 4305 Windsor Centre Trl Suite 300 Flower Mound |
| State: | TX US |
| Postal Code: | 750281864 |
| Phone Number: | 2143923070 |
| Fax Number: | |
| NPI Enumeration Date: | 07/27/2012 |
| NPI Last Update Date: | 07/27/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 558572 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |