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NPI Code Detail

MEDICARE: KATRYNA KUSTWAN

MEDICARE: KATRYNA KUSTWAN
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
1106S00000XBehavior TechnicianRBT-20-138350TX

General Provider Information

NPI Number : 1851990451
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATRYNA KUSTWAN
Provider Business Mailing Address
First Line : 189 N PLANO RD STE 100
Second Line :
City : RICHARDSON
State : TX
Zip : 75081-8001
Country : US
Telephone Number : 469-828-8252
Fax Number :
Provider Business Practice Location Address
First Line : 189 N PLANO RD STE 100
Second Line :
City : RICHARDSON
State : TX
Zip : 75081-8001
Country : US
Telephone Number : 469-828-8252
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2020
Last Update Date : 03/22/2021

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