Provider Demographics
NPI:1215150453
Name:KESSLER, DARYLL MARK (LP, CCP)
Entity type:Individual
Prefix:
First Name:DARYLL
Middle Name:MARK
Last Name:KESSLER
Suffix:
Gender:M
Credentials:LP, CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 WORTH ST STE 725
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2089
Mailing Address - Country:US
Mailing Address - Phone:214-824-2510
Mailing Address - Fax:
Practice Address - Street 1:3409 WORTH ST STE 725
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2089
Practice Address - Country:US
Practice Address - Phone:214-824-2510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPF0512242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist