Healthcare Provider Details

I. General information

NPI: 1174817126
Provider Name (Legal Business Name): KS GIFTED SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 06/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S SPRING CREEK DR
RICHARDSON TX
75081-4713
US

IV. Provider business mailing address

111 S SPRING CREEK DR
RICHARDSON TX
75081-4713
US

V. Phone/Fax

Practice location:
  • Phone: 817-637-2362
  • Fax:
Mailing address:
  • Phone: 817-637-2362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: KEISHA RENEE FERGUSON
Title or Position: OWNER
Credential:
Phone: 817-637-2362