Provider Demographics
NPI:1063801736
Name:KINSLEY, CALLIE (CPNP)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:KINSLEY
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 LAKEVIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-4537
Mailing Address - Country:US
Mailing Address - Phone:972-412-3034
Mailing Address - Fax:972-412-3695
Practice Address - Street 1:9100 LAKEVIEW PKWY
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-4537
Practice Address - Country:US
Practice Address - Phone:972-412-3034
Practice Address - Fax:972-412-3695
Is Sole Proprietor?:No
Enumeration Date:2015-01-17
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127322363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics