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General NPI Number Information
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NPI Number | 1255292785
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Entity Type | Organization
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Legal Business Name | KIDSVILLE PEDIATRICS PROSPER
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Dates
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Enumeration Date | 11/24/2025
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 1400 N COIT RD STE 1604
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City | MCKINNEY
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State | TX
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Zip | 75071-6661
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Country | US
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Telephone | 682-868-1020
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 N COIT RD STE 1604
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City | MCKINNEY
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State | TX
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Zip | 75071-6661
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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 | EXECUTIVE MANAGER
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Name | ALI SHAH
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Credential |
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Telephone | 682-868-1020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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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 | 2278P1006X
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Taxonomy Name | Pulmonary Function Technologist Certified Respiratory Therapist
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number |
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License Number State |
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