MEDICARE: KRISTIN MELYNN CORKINS FNP

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	363LF0000X	Family Nurse Practitioner	AP128120	TX

General Provider Information

NPI Number	:	1811372873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN MELYNN CORKINS FNP

Provider Business Mailing Address
First Line	:	12465 TIMBERLAND BLVD STE 401
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5215
Country	:	US
Telephone Number	:	817-741-8355
Fax Number	:	817-741-8365

Provider Business Practice Location Address
First Line	:	12465 TIMBERLAND BLVD STE 401
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5215
Country	:	US
Telephone Number	:	817-741-8355
Fax Number	:	817-741-8365

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

Provider Enumeration Date	:	07/20/2015
Last Update Date	:	12/04/2015

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