MEDICARE: DAVY KRANG

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	363LP0200X	Pediatric Nurse Practitioner	1158734	TX

General Provider Information

NPI Number	:	1770326142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVY KRANG

Provider Business Mailing Address
First Line	:	1235 LYNN DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76002-4342
Country	:	US
Telephone Number	:	214-606-1964
Fax Number	:

Provider Business Practice Location Address
First Line	:	1759 BROAD PARK CIR S STE 201
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-7834
Country	:	US
Telephone Number	:	682-341-3910
Fax Number	:

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

Provider Enumeration Date	:	06/14/2024
Last Update Date	:	06/25/2024

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