Healthcare Provider Details

I. General information

NPI: 1932742558
Provider Name (Legal Business Name): KAITH MERLIN ANNE GUINTU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2019
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HILLCREST MEDICAL BLVD
WACO TX
76712-8897
US

IV. Provider business mailing address

PO BOX 844658 2401 S 31ST ST MS -AR-M200
DALLAS TX
75284-4658
US

V. Phone/Fax

Practice location:
  • Phone: 254-724-2111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA17436
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: