Healthcare Provider Details

I. General information

NPI: 1083582621
Provider Name (Legal Business Name): KINDALYNN MICKENZIE LYNN HULSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 10/30/2025
Certification Date: 10/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28111 S FIRETHORNE RD
KATY TX
77494-0306
US

IV. Provider business mailing address

24949 KATY RANCH RD
KATY TX
77494-7153
US

V. Phone/Fax

Practice location:
  • Phone: 281-971-0766
  • Fax: 281-971-0766
Mailing address:
  • Phone: 281-971-0766
  • Fax: 281-971-0766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: