Healthcare Provider Details

I. General information

NPI: 1114160397
Provider Name (Legal Business Name): REAGAN LYNN KINNEAR PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REAGAN LYNN RINDERKNECHT PH.D.

II. Dates (important events)

Enumeration Date: 04/17/2009
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 EL CHICO TRL STE 105
WILLOW PARK TX
76087-8862
US

IV. Provider business mailing address

134 EL CHICO TRL STE 105
WILLOW PARK TX
76087-8862
US

V. Phone/Fax

Practice location:
  • Phone: 682-333-1533
  • Fax:
Mailing address:
  • Phone: 682-333-1533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number37167
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: