Healthcare Provider Details

I. General information

NPI: 1912862699
Provider Name (Legal Business Name): ORTHOLONESTAR, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 S PALESTINE ST STE 300
ATHENS TX
75751-3645
US

IV. Provider business mailing address

4700 SETON CENTER PKWY STE 115
AUSTIN TX
78759-5753
US

V. Phone/Fax

Practice location:
  • Phone: 903-939-7500
  • Fax:
Mailing address:
  • Phone: 346-440-0645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER KINMAN
Title or Position: VP QUALITY & REGULATORY AFFAIRS
Credential:
Phone: 346-447-9004