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General NPI Number Information
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NPI Number | 1043229461
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Entity Type | Organization
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Legal Business Name | CARDINAL MEDICAL SERVICES, INC.
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1615 PRECINCT LINE RD SUITE 105A
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City | HURST
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State | TX
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Zip | 76054-3345
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Country | US
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Telephone | 817-605-8777
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Fax | 817-605-8779
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Provider Business Mailing Address
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Address Line | 1615 PRECINCT LINE RD SUITE 105A
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City | HURST
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State | TX
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Zip | 76054-3345
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Country | US
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Telephone | 817-590-2275
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Fax | 817-605-8779
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. DEBORAH S. MCKNIGHT
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Credential | R.N., A.N.P.
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Telephone | 817-590-2275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 531803
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License Number State | TX
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