Provider Demographics
NPI:1548945991
Name:KINDIG, NATHANAEL RAY
Entity type:Individual
Prefix:
First Name:NATHANAEL
Middle Name:RAY
Last Name:KINDIG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7410 BLANCO RD STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-4394
Mailing Address - Country:US
Mailing Address - Phone:210-838-5351
Mailing Address - Fax:
Practice Address - Street 1:7410 BLANCO RD STE 400
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4394
Practice Address - Country:US
Practice Address - Phone:210-838-5351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71999103TS0200X
TX39549103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool