Provider Demographics
NPI:1699923078
Name:BOBBITT, KALAN NICOLE (DO)
Entity type:Individual
Prefix:DR
First Name:KALAN
Middle Name:NICOLE
Last Name:BOBBITT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 E STATE HIGHWAY 114
Mailing Address - Street 2:STE 100
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-5253
Mailing Address - Country:US
Mailing Address - Phone:817-329-8364
Mailing Address - Fax:817-329-1285
Practice Address - Street 1:10900 FOUNDERS WAY STE 103
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5435
Practice Address - Country:US
Practice Address - Phone:817-741-8355
Practice Address - Fax:817-329-1285
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4950207Q00000X
TXBP10032391207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine