MEDICARE: RHIANNON KELLY SKINNER PA

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	363AM0700X	Medical Physician Assistant
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1942651799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RHIANNON KELLY SKINNER PA

Provider Business Mailing Address
First Line	:	4900 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-7719
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4900 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-7719
Country	:	US
Telephone Number	:	214-590-5524
Fax Number	:

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

Provider Enumeration Date	:	06/23/2016
Last Update Date	:	05/14/2025

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