=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013809219
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KPS VENTURES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2025
-----------------------------------------------------
Last Update Date | 07/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12228 N CENTRAL EXPY STE 360
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75243-3779
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-550-0033
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 904 ASPEN RIDGE DR
-----------------------------------------------------
City | SOUTHLAKE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76092-3826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-550-0033
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KELLY SCHULTZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 214-550-0033
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------