Provider Demographics
NPI:1063966075
Name:PRICE, KIZZY (RN, MSN, NP-C)
Entity type:Individual
Prefix:
First Name:KIZZY
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:RN, MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 N CEDAR RIDGE DR STE 210
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-3169
Mailing Address - Country:US
Mailing Address - Phone:214-400-2805
Mailing Address - Fax:469-759-6994
Practice Address - Street 1:407 N CEDAR RIDGE DR STE 210
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116
Practice Address - Country:US
Practice Address - Phone:469-364-1300
Practice Address - Fax:460-759-6994
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131002363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01830999OtherRAILROAD
TX363371101Medicaid
TX363371101Medicaid