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NPI Code Detail

MEDICARE: MRS. KRISTINA MCKINLEY CABALLERO PA-C

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
1363A00000XPhysician AssistantPA06645TX
2363A00000XPhysician AssistantPA6103MA
3363AM0700XMedical Physician AssistantPA06645TX
4363AS0400XSurgical Physician AssistantPA06645TX
5363A00000XPhysician AssistantPA.0006174CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PA06645OTHERTXLICENSE

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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Directions to “ MRS. KRISTINA MCKINLEY CABALLERO PA-C” Practice Location

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