Healthcare Provider Details

I. General information

NPI: 1194144246
Provider Name (Legal Business Name): KISH L. CARLTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 12/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 US HIGHWAY 271 N
PITTSBURG TX
75686-4289
US

IV. Provider business mailing address

2701 US HIGHWAY 271 N
PITTSBURG TX
75686-4289
US

V. Phone/Fax

Practice location:
  • Phone: 903-946-5442
  • Fax: 903-946-5258
Mailing address:
  • Phone: 903-946-5442
  • Fax: 903-946-5258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR4948
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: