MEDICARE: KASEY RENFRO

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	235Z00000X	Speech-Language Pathologist	114874	TX

General Provider Information

NPI Number	:	1568089811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASEY RENFRO

Provider Business Mailing Address
First Line	:	8101 BOAT CLUB RD STE 240-319
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76179-3630
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 SPROLES DR STE 120
Second Line	:
City	:	BENBROOK
State	:	TX
Zip	:	76126-3249
Country	:	US
Telephone Number	:	682-500-1601
Fax Number	:

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

Provider Enumeration Date	:	07/02/2020
Last Update Date	:	10/07/2025

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Directions to “ KASEY RENFRO ” Practice Location

Language	Start Address	Practice Location

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