Healthcare Provider Details

I. General information

NPI: 1063801736
Provider Name (Legal Business Name): CALLIE KINSLEY CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2015
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

387 S TRADE DAYS BLVD
CANTON TX
75103-3314
US

IV. Provider business mailing address

10670 N CENTRAL EXPY STE 110
DALLAS TX
75231-2105
US

V. Phone/Fax

Practice location:
  • Phone: 214-250-3858
  • Fax: 866-728-9963
Mailing address:
  • Phone: 214-250-3858
  • Fax: 866-728-9963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP127322
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: