Organization Name: | KERRVILLE PEDIATRICS |
NPI Number: | 1114292968 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CONNIE LEA WHIITNG (PRACTICE MANAGER) |
Mailing Address: | 1331 Bandera Hwy Suite 10 Kerrville |
State: | TX US |
Postal Code: | 780289535 |
Phone Number: | 8302571440 |
Fax Number: | 8302572542 |
NPI Enumeration Date: | 03/13/2012 |
NPI Last Update Date: | 03/13/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 364SP0200X |
License Number: | 230898 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Clinical Nurse Specialist |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |