| Pediatric Kare Klinic Pllc | |
|
104 E Us Highway 80 Ste 190 Forney TX 75126-8615 | |
| (469) 602-5277 | |
| (469) 995-7898 |
| Full Name | Pediatric Kare Klinic Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 104 E Us Highway 80 Ste 190, Forney, Texas |
| Authorized Official Name and Position | Deloris Renee Harwell (PEDIATRIC NURSE PRACTITIONER) |
| Authorized Official Contact | 4696025277 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Kare Klinic Pllc 104 E Us Highway 80 Ste 190 Forney TX 75126-8615 Ph: (469) 602-5277 | Pediatric Kare Klinic Pllc 104 E Us Highway 80 Ste 190 Forney TX 75126-8615 Ph: (469) 602-5277 |
| NPI Number | 1609348580 |
|---|---|
| Provider Enumeration Date | 12/17/2018 |
| Last Update Date | 03/12/2020 |
| Medicare PECOS PAC ID | 4486980315 |
|---|---|
| Medicare Enrollment ID | O20190730001907 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609348580 | NPI | - | NPPES |
| 407416301 | Medicaid | TX | |
| 407416302 | Other | TX | TEXAS HEALTH STEPS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Deloris R Harwell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346478252 PECOS PAC ID: 8022161892 Enrollment ID: I20090728000243 |
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