Provider Demographics
NPI:1023364049
Name:PEDIATRIC HEALTH PARTNERS PLLC
Entity Type:Organization
Organization Name:PEDIATRIC HEALTH PARTNERS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOKOUT
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:214-392-3070
Mailing Address - Street 1:4305 WINDSOR CENTRE TRL
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1864
Mailing Address - Country:US
Mailing Address - Phone:214-392-3070
Mailing Address - Fax:
Practice Address - Street 1:4305 WINDSOR CENTRE TRL
Practice Address - Street 2:SUITE 300
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1864
Practice Address - Country:US
Practice Address - Phone:214-392-3070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX558572363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty