MEDICARE: KINDRA MCWILLIAM-ROSS APRN

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	364SA2200X	Adult Health Clinical Nurse Specialist	AP118550	TX

General Provider Information

NPI Number	:	1740871532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KINDRA MCWILLIAM-ROSS APRN

Provider Business Mailing Address
First Line	:	4600 MAYWOOD DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-1329
Country	:	US
Telephone Number	:	817-980-1656
Fax Number	:

Provider Business Practice Location Address
First Line	:	4600 MAYWOOD DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-1329
Country	:	US
Telephone Number	:	817-980-1656
Fax Number	:

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

Provider Enumeration Date	:	02/03/2021
Last Update Date	:	02/03/2021

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