Healthcare Provider Details

I. General information

NPI: 1932948189
Provider Name (Legal Business Name): KINZI LEA SELF APRN, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 HERITAGE TRACE PKWY STE 117
FORT WORTH TX
76244-8910
US

IV. Provider business mailing address

3030 HARWOOD RD STE 100
BEDFORD TX
76021-3703
US

V. Phone/Fax

Practice location:
  • Phone: 817-267-6290
  • Fax: 817-267-0950
Mailing address:
  • Phone: 817-267-6290
  • Fax: 817-267-0950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1194805
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: