MEDICARE: MRS. KRISTINA MCKINLEY CABALLERO PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA06645	TX
2	363A00000X	Physician Assistant	PA6103	MA
3	363AM0700X	Medical Physician Assistant	PA06645	TX
4	363AS0400X	Surgical Physician Assistant	PA06645	TX
5	363A00000X	Physician Assistant	PA.0006174	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA06645	OTHER	TX	LICENSE

General Provider Information

NPI Number	:	1326361882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTINA MCKINLEY CABALLERO PA-C

Provider Business Mailing Address
First Line	:	5200 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TEXAS
Zip	:	75214
Country	:	UM
Telephone Number	:	817-507-0794
Fax Number	:	817-507-0795

Provider Business Practice Location Address
First Line	:	7208 MEADOW LAKE AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-3526
Country	:	US
Telephone Number	:	508-737-7202
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2010
Last Update Date	:	08/11/2020

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