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NPI Code Detail

MEDICARE: 22KILL

MEDICARE: 22KILL
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
12084P0800XPsychiatry Physician
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1811524085
Entity Type Code : Organization
Provider Name (Legal Business Name) : 22KILL
Provider Business Mailing Address
First Line : 855 TEXAS ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76102-4572
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 855 TEXAS ST STE 105
Second Line :
City : FORT WORTH
State : TX
Zip : 76102-4574
Country : US
Telephone Number : 682-990-6242
Fax Number :
Authorized Official
Title or Position : COO
Name : MRS. TEMPA SHERRILL
Credential :
Telephone Number : 817-734-4854
Provider Enumeration Date : 03/26/2020
Last Update Date : 03/26/2020

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Directions to “22KILL ” Practice Location

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