Healthcare Provider Details

I. General information

NPI: 1376061796
Provider Name (Legal Business Name): KINSLEY QUEEN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7981 LITTLE STREET
HOUSTON TX
77028
US

IV. Provider business mailing address

PO BOX 550305
HOUSTON TX
77255-0305
US

V. Phone/Fax

Practice location:
  • Phone: 281-683-5053
  • Fax:
Mailing address:
  • Phone: 281-683-5053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number23840944
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number StateTX
# 7
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number23840944
License Number StateTX

VIII. Authorized Official

Name: WALLACE HARRIS II
Title or Position: DIRECTOR
Credential:
Phone: 281-683-5053