MEDICARE: CASEY LYNN KINMAN M.D.

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	207VF0040X	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician	R0890	TX

General Provider Information

NPI Number	:	1306161112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY LYNN KINMAN M.D.

Provider Business Mailing Address
First Line	:	2001 N MACARTHUR BLVD STE 425
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75061-2299
Country	:	US
Telephone Number	:	817-680-0597
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 N MACARTHUR BLVD STE 425
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75061-2299
Country	:	US
Telephone Number	:	469-800-1330
Fax Number	:	469-800-1340

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

Provider Enumeration Date	:	04/05/2010
Last Update Date	:	04/04/2022

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