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General NPI Number Information
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NPI Number | 1134473069
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Entity Type | Individual
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Provider Name | KALI CHLORIN FAGNANT
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Gender | Female
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Dates
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Enumeration Date | 10/30/2012
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 15022 TUFF RD
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City | MANOR
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State | TX
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Zip | 78653-2344
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Country | US
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Telephone | 307-254-0572
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Fax |
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Provider Business Mailing Address
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Address Line | 15022 TUFF RD
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City | MANOR
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State | TX
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Zip | 78653-2344
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 59803
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License Number State | TX
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