Healthcare Provider Details

I. General information

NPI: 1780183442
Provider Name (Legal Business Name): KID APPROVED PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11875 COIT ROAD SUITE 100
FRISCO TX
75035
US

IV. Provider business mailing address

11875 COIT ROAD SUITE 100
FRISCO TX
75035
US

V. Phone/Fax

Practice location:
  • Phone: 972-787-0044
  • Fax: 214-382-0065
Mailing address:
  • Phone: 972-787-0044
  • Fax: 214-382-0065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL8525
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number781962
License Number StateTX

VIII. Authorized Official

Name: LILYAN BLATT
Title or Position: OWNER
Credential: DO
Phone: 972-787-0044