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NPI Code Detail

MEDICARE: KINZI LEA SELF APRN, AGACNP-BC

MEDICARE: KINZI LEA SELF APRN, AGACNP-BC
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
1363L00000XNurse Practitioner1194805TX

General Provider Information

NPI Number : 1932948189
Entity Type Code : Individual
Provider Name (Legal Business Name) : KINZI LEA SELF APRN, AGACNP-BC
Provider Business Mailing Address
First Line : 3030 HARWOOD RD STE 100
Second Line :
City : BEDFORD
State : TX
Zip : 76021-3703
Country : US
Telephone Number : 817-267-6290
Fax Number : 817-267-0950
Provider Business Practice Location Address
First Line : 4525 HERITAGE TRACE PKWY STE 117
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-8910
Country : US
Telephone Number : 817-267-6290
Fax Number : 817-267-0950
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2024
Last Update Date : 12/05/2025

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Directions to “ KINZI LEA SELF APRN, AGACNP-BC” Practice Location

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