MEDICARE: NTKC - DFW, PLLC

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	207RN0300X	Nephrology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174804611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NTKC - DFW, PLLC

Provider Business Mailing Address
First Line	:	3801 WILLIAM D TATE AVE STE 105
Second Line	:
City	:	GRAPEVINE
State	:	TX
Zip	:	76051-8755
Country	:	US
Telephone Number	:	817-488-6812
Fax Number	:	817-251-1303

Provider Business Practice Location Address
First Line	:	7250 HAWKINS VIEW DR
Second Line	:	SUITE 410
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3920
Country	:	US
Telephone Number	:	817-294-0280
Fax Number	:	817-294-2084

Authorized Official
Title or Position	:	CFO
Name	:	DAN N BACCUS
Credential	:
Telephone Number	:	817-488-6669

Provider Enumeration Date	:	08/29/2011
Last Update Date	:	06/27/2019

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