Healthcare Provider Details

I. General information

NPI: 1336333806
Provider Name (Legal Business Name): INWOOD VILLAGE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5470 W. LOVERS LANE SUITE 330
DALLAS TX
75209
US

IV. Provider business mailing address

5470 W. LOVERS LANE SUITE 330
DALLAS TX
75209
US

V. Phone/Fax

Practice location:
  • Phone: 214-956-7337
  • Fax: 214-466-8289
Mailing address:
  • Phone: 214-956-7337
  • Fax: 214-466-8289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL4488
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberL4488
License Number StateTX

VIII. Authorized Official

Name: DR. TAMMY L KENNEDY
Title or Position: PARTNER/OWNER
Credential: M.D.
Phone: 214-956-7337