1356210538 NPI number — CLARK COLVILLE AND KELLY HEETLAND SPECIALTY PARTNERS OF TEXAS PLLC

NPI Number: 1356210538
Health Care Provider/Practitioner: CLARK COLVILLE AND KELLY HEETLAND SPECIALTY PARTNERS OF TEXAS PLLC

NPI Number : 1356210538 – XML Data Format

                    
<?xml version="1.0" encoding="UTF-8"?>
<Npi>
	<NPI>
		1356210538
	</NPI>
	<EntityType>
		Organization
	</EntityType>
	<ReplacementNPI/>
	<EIN/>
	<IsSoleProprietor/>
	<IsOrgSubpart>
		Y
	</IsOrgSubpart>
	<ParentOrgLBN>
		CLARK COLVILLE AND KELLY HEETLAND SPECIALTY PARTNERS OF TEXAS PLLC
	</ParentOrgLBN>
	<ParentOrgTIN/>
	<OrgName>
		CLARK COLVILLE AND KELLY HEETLAND SPECIALTY PARTNERS OF TEXAS PLLC
	</OrgName>
	<LastName/>
	<FirstName/>
	<MiddleName/>
	<NamePrefix/>
	<NameSuffix/>
	<Credential/>
	<OtherOrgName/>
	<OtherOrgNameTypeCode/>
	<OtherLastName/>
	<OtherFirstName/>
	<OtherMiddleName/>
	<OtherNamePrefix/>
	<OtherNameSuffix/>
	<OtherCredential/>
	<OtherLastNameTypeCode/>
	<FirstLineMailingAddress>
		820 W 42ND ST
	</FirstLineMailingAddress>
	<SecondLineMailingAddress/>
	<MailingAddressCityName>
		SCOTTSBLUFF
	</MailingAddressCityName>
	<MailingAddressStateName>
		NE
	</MailingAddressStateName>
	<MailingAddressPostalCode>
		69361-4708
	</MailingAddressPostalCode>
	<MailingAddressCountryCode>
		US
	</MailingAddressCountryCode>
	<MailingAddressTelephoneNumber>
		308-260-0241
	</MailingAddressTelephoneNumber>
	<MailingAddressFaxNumber/>
	<FirstLinePracticeLocationAddress>
		2211 MIDWESTERN PKWY STE 1
	</FirstLinePracticeLocationAddress>
	<SecondLinePracticeLocationAddress/>
	<PracticeLocationAddressCityName>
		WICHITA FALLS
	</PracticeLocationAddressCityName>
	<PracticeLocationAddressStateName>
		TX
	</PracticeLocationAddressStateName>
	<PracticeLocationAddressPostalCode>
		76308-2300
	</PracticeLocationAddressPostalCode>
	<PracticeLocationAddressCountryCode>
		US
	</PracticeLocationAddressCountryCode>
	<PracticeLocationAddressTelephoneNumber>
		940-691-2911
	</PracticeLocationAddressTelephoneNumber>
	<PracticeLocationAddressFaxNumber/>
	<EnumerationDate>
		11/04/2025
	</EnumerationDate>
	<LastUpdateDate>
		11/04/2025
	</LastUpdateDate>
	<NPIDeactivationReasonCode/>
	<NPIDeactivationReason/>
	<NPIDeactivationDate/>
	<NPIReactivationDate/>
	<GenderCode/>
	<Gender/>
	<AuthorizedOfficialLastName>
		RICHARDSON
	</AuthorizedOfficialLastName>
	<AuthorizedOfficialFirstName>
		KRYSTAL
	</AuthorizedOfficialFirstName>
	<AuthorizedOfficialMiddleName/>
	<AuthorizedOfficialTitle>
		DIRECTOR OF RCM
	</AuthorizedOfficialTitle>
	<AuthorizedOfficialNamePrefix/>
	<AuthorizedOfficialNameSuffix/>
	<AuthorizedOfficialCredential/>
	<AuthorizedOfficialTelephoneNumber>
		214-934-7995
	</AuthorizedOfficialTelephoneNumber>
	<Taxonomies>
		<Taxonomy>
			<TaxonomyCode>
				1223X0400X
			</TaxonomyCode>
			<TaxonomyName>
				Orthodontics and Dentofacial Orthopedics Dentistry
			</TaxonomyName>
			<LicenseNumber/>
			<LicenseNumberStateCode/>
			<PrimaryTaxonomySwitch>
				Y
			</PrimaryTaxonomySwitch>
		</Taxonomy>
	</Taxonomies>
	<HealthcareProviderTaxonomyGroups>
		<HealthcareProviderTaxonomyGroup>
			<HealthcareProviderTaxonomyGroupName>
				193200000X MULTI-SPECIALTY GROUP
			</HealthcareProviderTaxonomyGroupName>
			<HealthcareProviderTaxonomyGroupDescription>
				Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization.
			</HealthcareProviderTaxonomyGroupDescription>
		</HealthcareProviderTaxonomyGroup>
	</HealthcareProviderTaxonomyGroups>
</Npi>

                    
                

NPI Number XSD (XML Schema Definition)

                
<?xml version="1.0" encoding="UTF-8"?>
   <xs:schema xmlns:xs="http://www.w3.org/2001/XMLSchema" elementFormDefault="qualified" attributeFormDefault="unqualified">
         <xs:element name="Npi">
               <xs:complexType>
                     <xs:sequence>
                           <xs:element name="NPI" type="xs:int"></xs:element>
                           <xs:element name="EntityType" type="xs:string"></xs:element>
                           <xs:element name="ReplacementNPI"></xs:element>
                           <xs:element name="EIN"></xs:element>
                           <xs:element name="IsSoleProprietor" type="xs:string"></xs:element>
                           <xs:element name="IsOrgSubpart"></xs:element>
                           <xs:element name="ParentOrgLBN"></xs:element>
                           <xs:element name="ParentOrgTIN"></xs:element>
                           <xs:element name="OrgName"></xs:element>
                           <xs:element name="LastName" type="xs:string"></xs:element>
                           <xs:element name="FirstName" type="xs:string"></xs:element>
                           <xs:element name="MiddleName"></xs:element>
                           <xs:element name="NamePrefix" type="xs:string"></xs:element>
                           <xs:element name="NameSuffix"></xs:element>
                           <xs:element name="Credential" type="xs:string"></xs:element>
                           <xs:element name="OtherOrgName"></xs:element>
                           <xs:element name="OtherOrgNameTypeCode"></xs:element>
                           <xs:element name="OtherLastName"></xs:element>
                           <xs:element name="OtherFirstName"></xs:element>
                           <xs:element name="OtherMiddleName"></xs:element>
                           <xs:element name="OtherNamePrefix"></xs:element>
                           <xs:element name="OtherNameSuffix"></xs:element>
                           <xs:element name="OtherCredential"></xs:element>
                           <xs:element name="OtherLastNameTypeCode"></xs:element>
                           <xs:element name="FirstLineMailingAddress" type="xs:string"></xs:element>
                           <xs:element name="SecondLineMailingAddress"></xs:element>
                           <xs:element name="MailingAddressCityName" type="xs:string"></xs:element>
                           <xs:element name="MailingAddressStateName" type="xs:string"></xs:element>
                           <xs:element name="MailingAddressPostalCode" type="xs:string"></xs:element>
                           <xs:element name="MailingAddressCountryCode" type="xs:string"></xs:element>
                           <xs:element name="MailingAddressTelephoneNumber" type="xs:string"></xs:element>
                           <xs:element name="MailingAddressFaxNumber"></xs:element>
                           <xs:element name="FirstLinePracticeLocationAddress" type="xs:string"></xs:element>
                           <xs:element name="SecondLinePracticeLocationAddress" type="xs:string"></xs:element>
                           <xs:element name="PracticeLocationAddressCityName" type="xs:string"></xs:element>
                           <xs:element name="PracticeLocationAddressStateName" type="xs:string"></xs:element>
                           <xs:element name="PracticeLocationAddressPostalCode" type="xs:string"></xs:element>
                           <xs:element name="PracticeLocationAddressCountryCode" type="xs:string"></xs:element>
                           <xs:element name="PracticeLocationAddressTelephoneNumber" type="xs:string"></xs:element>
                           <xs:element name="PracticeLocationAddressFaxNumber"></xs:element>
                           <xs:element name="EnumerationDate" type="xs:string"></xs:element>
                           <xs:element name="LastUpdateDate" type="xs:string"></xs:element>
                           <xs:element name="NPIDeactivationReasonCode"></xs:element>
                           <xs:element name="NPIDeactivationReason"></xs:element>
                           <xs:element name="NPIDeactivationDate"></xs:element>
                           <xs:element name="NPIReactivationDate"></xs:element>
                           <xs:element name="GenderCode" type="xs:string"></xs:element>
                           <xs:element name="Gender" type="xs:string"></xs:element>
                           <xs:element name="AuthorizedOfficialLastName"></xs:element>
                           <xs:element name="AuthorizedOfficialFirstName"></xs:element>
                           <xs:element name="AuthorizedOfficialMiddleName"></xs:element>
                           <xs:element name="AuthorizedOfficialTitle"></xs:element>
                           <xs:element name="AuthorizedOfficialNamePrefix"></xs:element>
                           <xs:element name="AuthorizedOfficialNameSuffix"></xs:element>
                           <xs:element name="AuthorizedOfficialCredential"></xs:element>
                           <xs:element name="AuthorizedOfficialTelephoneNumber"></xs:element>
                           <xs:element name="Taxonomies">
                                 <xs:complexType>
                                       <xs:sequence>
                                             <xs:element name="Taxonomy" maxOccurs="unbounded">
                                                   <xs:complexType>
                                                         <xs:sequence>
                                                               <xs:element name="TaxonomyCode" type="xs:string"></xs:element>
                                                               <xs:element name="TaxonomyName" type="xs:string"></xs:element>
                                                               <xs:element name="LicenseNumber" type="xs:string"></xs:element>
                                                               <xs:element name="LicenseNumberStateCode" type="xs:string"></xs:element>
                                                               <xs:element name="PrimaryTaxonomySwitch" type="xs:string"></xs:element>
                                                         </xs:sequence>
                                                   </xs:complexType>
                                             </xs:element>
                                       </xs:sequence>
                                 </xs:complexType>
                           </xs:element>
                           <xs:element name="OtherIdentifiers">
                                 <xs:complexType>
                                       <xs:sequence>
                                             <xs:element name="OtherIdentifier" maxOccurs="unbounded">
                                                   <xs:complexType>
                                                         <xs:sequence>
                                                               <xs:element name="OtherIdentifierName" type="xs:string"></xs:element>
                                                               <xs:element name="OtherIdentifierType" type="xs:string"></xs:element>
                                                               <xs:element name="OtherIdentifierState" type="xs:string"></xs:element>
                                                               <xs:element name="OtherIdentifierIssuer"></xs:element>
                                                         </xs:sequence>
                                                   </xs:complexType>
                                             </xs:element>
                                       </xs:sequence>
                                 </xs:complexType>
                           </xs:element>
                           <xs:element name="HealthcareProviderTaxonomyGroups"></xs:element>
                     </xs:sequence>
               </xs:complexType>
         </xs:element>
   </xs:schema>