=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942958558
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAMISA & ASSOCIATES FAMILY CLINIC AND URGENT CARE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2022
-----------------------------------------------------
Last Update Date | 03/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7219 SIERRA WAY
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75241-5724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-732-9781
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7219 SIERRA WAY
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75241-5724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-732-9781
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BOBBIE SNOW MASENDA
-----------------------------------------------------
Credential | FNP-BC
-----------------------------------------------------
Telephone | 469-732-9781
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------