Healthcare Provider Details

I. General information

NPI: 1548945991
Provider Name (Legal Business Name): NATHANAEL RAY KINDIG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7410 BLANCO RD STE 400
SAN ANTONIO TX
78216-4394
US

IV. Provider business mailing address

7410 BLANCO RD STE 400
SAN ANTONIO TX
78216-4394
US

V. Phone/Fax

Practice location:
  • Phone: 210-838-5351
  • Fax:
Mailing address:
  • Phone: 210-838-5351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number71999
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number39549
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: