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NPI Code Detail

MEDICARE: RYAN P KENDRICK PAC

MEDICARE: RYAN P KENDRICK PAC
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
1363AM0700XMedical Physician Assistant
2363A00000XPhysician AssistantPA06641TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3P01021938OTHERTXRAILROAD

General Provider Information

NPI Number : 1386821213
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN P KENDRICK PAC
Provider Business Mailing Address
First Line : 3529 HERITAGE TRACE PKWY STE 137
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-4971
Country : US
Telephone Number : 817-741-7960
Fax Number : 817-741-7581
Provider Business Practice Location Address
First Line : 3529 HERITAGE TRACE PKWY STE 137
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-4971
Country : US
Telephone Number : 817-741-7960
Fax Number : 817-741-7581
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2008
Last Update Date : 01/21/2015

Similar Medicare Providers

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Practice Location Address:
3529 HERITAGE TRACE PKWY STE 137
FORT WORTH, TX
76244-4971
Practice Phone: 817-741-7960
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1770556698 — FAWN MARIE WILLARD FNP
Practice Location Address:
3529 HERITAGE TRACE PKWY STE 137
FORT WORTH, TX
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Practice Phone: 817-741-7960
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1497056071 — AMBER RENEE MAYES PA-C
Practice Location Address:
3529 HERITAGE TRACE PKWY STE 137
FORT WORTH, TX
76244-4971
Practice Phone: 817-741-7960
Practice Fax: 817-741-7581
1669736617 — JAMIE L GULLY NP
Practice Location Address:
3529 HERITAGE TRACE PKWY STE 137
FORT WORTH, TX
76244-4971
Practice Phone: 817-741-7960
Practice Fax: 817-741-7581
1225449788 — MRS. LATHA MATHEW THOMAS RN,FNP
Practice Location Address:
3529 HERITAGE TRACE PKWY STE 137
FORT WORTH, TX
76244-4971
Practice Phone: 817-741-7570
Practice Fax:
1487307518 — RAMU GUNDA RPH
Practice Location Address:
3529 HERITAGE TRACE PKWY STE 141
FORT WORTH, TX
76244-4971
Practice Phone: 817-741-7100
Practice Fax: 817-741-7101

Directions to “ RYAN P KENDRICK PAC” Practice Location

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