Healthcare Provider Details

I. General information

NPI: 1700132958
Provider Name (Legal Business Name): KENDRA ANN GUMP FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 CAROLYN LN
ALLEN TX
75002-3631
US

IV. Provider business mailing address

5201 HARRY HINES BLVD
DALLAS TX
75235-7708
US

V. Phone/Fax

Practice location:
  • Phone: 214-208-7951
  • Fax:
Mailing address:
  • Phone: 214-590-6989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number641787
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: