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General NPI Number Information
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NPI Number | 1528520939
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Entity Type | Individual
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Provider Name | KRISTIN A NANKERVIS MD
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Gender | Female
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Dates
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Enumeration Date | 04/03/2019
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Last Update Date | 05/15/2023
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Provider Practice Location Address
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Address Line | 7217 TELECOM PKWY STE 100
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City | GARLAND
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State | TX
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Zip | 75044-2203
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Country | US
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Telephone | 469-669-0306
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Fax |
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Provider Business Mailing Address
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Address Line | 7217 TELECOM PKWY STE 100
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City | GARLAND
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State | TX
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Zip | 75044-2203
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Country | US
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Telephone | 214-207-0612
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 125075024
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License Number State | IL
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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 | T8607
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License Number State | TX
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