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General NPI Number Information
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NPI Number | 1427531128
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Entity Type | Organization
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Legal Business Name | NORTH TEXAS INTEGRATED MEDICAL PLLC
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Dates
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Enumeration Date | 09/10/2018
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Last Update Date | 09/10/2018
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Provider Practice Location Address
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Address Line | 4708 W PLANO PKWY STE 300
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City | PLANO
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State | TX
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Zip | 75093-5336
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Country | US
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Telephone | 972-265-8101
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Fax |
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Provider Business Mailing Address
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Address Line | 4708 W PLANO PKWY STE 300
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City | PLANO
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State | TX
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Zip | 75093-5336
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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 | MEMBER
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Name | DR. MARY KIRWAN
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Credential | DC
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Telephone | 972-265-8101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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