Provider Demographics
NPI:1487080222
Name:TULK, KANDACE O (PA)
Entity type:Individual
Prefix:
First Name:KANDACE
Middle Name:O
Last Name:TULK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9101
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-9494
Mailing Address - Country:US
Mailing Address - Phone:972-745-7500
Mailing Address - Fax:972-745-4336
Practice Address - Street 1:645 E STATE HIGHWAY 121
Practice Address - Street 2:SUITE 600
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-7942
Practice Address - Country:US
Practice Address - Phone:972-745-7500
Practice Address - Fax:972-745-4336
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2014-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA08717363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant