Healthcare Provider Details

I. General information

NPI: 1942803705
Provider Name (Legal Business Name): CALLYN ELIZABETH KOWALEWSKI PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 MEDICAL DISTRICT DR
DALLAS TX
75235-7701
US

IV. Provider business mailing address

3534 ORCHARD RIDGE CT
DALLAS TX
75229-2624
US

V. Phone/Fax

Practice location:
  • Phone: 214-456-6040
  • Fax: 214-456-6320
Mailing address:
  • Phone: 214-516-3707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number782103
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1012022
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: