Healthcare Provider Details

I. General information

NPI: 1952403412
Provider Name (Legal Business Name): TERESA HILL KINSFATHER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 S MAIN ST
GIDDINGS TX
78942-4118
US

IV. Provider business mailing address

514 S MAIN ST P.O.BOX 390
GIDDINGS TX
78942-4118
US

V. Phone/Fax

Practice location:
  • Phone: 979-542-4357
  • Fax: 979-542-1010
Mailing address:
  • Phone: 979-542-4357
  • Fax: 979-542-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH6181
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: