Healthcare Provider Details

I. General information

NPI: 1730926965
Provider Name (Legal Business Name): KAYLENE MARIE CUADROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3144 HORIZON RD STE 210
ROCKWALL TX
75032-7047
US

IV. Provider business mailing address

PO BOX 35629
DALLAS TX
75235-0629
US

V. Phone/Fax

Practice location:
  • Phone: 972-771-2222
  • Fax: 972-771-3350
Mailing address:
  • Phone: 214-424-2200
  • Fax: 214-231-2159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1168521
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: