MEDICARE: KRISTE K HAILE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA00112	TX
2	363AS0400X	Surgical Physician Assistant	PA00112	TX

General Provider Information

NPI Number	:	1164561056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTE K HAILE PA

Provider Business Mailing Address
First Line	:	11970 N CENTRAL EXPY STE 210
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-3784
Country	:	US
Telephone Number	:	940-381-2003
Fax Number	:	940-483-1221

Provider Business Practice Location Address
First Line	:	11970 N CENTRAL EXPY STE 210
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-3784
Country	:	US
Telephone Number	:	214-575-5885
Fax Number	:	907-785-4662

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	09/15/2022

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Directions to “ KRISTE K HAILE PA” Practice Location

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