MEDICARE: KRISTIN GARNER FREEMAN 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	207Q00000X	Family Medicine Physician	Q4114	TX

General Provider Information

NPI Number	:	1316382906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN GARNER FREEMAN M.D.

Provider Business Mailing Address
First Line	:	5450 CLEARFORK MAIN ST STE 460
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-3560
Country	:	US
Telephone Number	:	817-423-5121
Fax Number	:	817-423-5122

Provider Business Practice Location Address
First Line	:	5450 CLEARFORK MAIN ST STE 460
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-3560
Country	:	US
Telephone Number	:	817-423-5121
Fax Number	:	817-423-5122

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

Provider Enumeration Date	:	05/08/2013
Last Update Date	:	02/15/2024

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