MEDICARE: KRISTIN KIRKLEY

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	10527	TX

General Provider Information

NPI Number	:	1801444005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN KIRKLEY

Provider Business Mailing Address
First Line	:	1604 DAKAR RD W
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-1818
Country	:	US
Telephone Number	:	817-713-2620
Fax Number	:

Provider Business Practice Location Address
First Line	:	1604 DAKAR RD W
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-1818
Country	:	US
Telephone Number	:	817-713-2620
Fax Number	:

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

Provider Enumeration Date	:	08/30/2019
Last Update Date	:	08/30/2019

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Directions to “ KRISTIN KIRKLEY ” Practice Location

Language	Start Address	Practice Location

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