Provider Demographics
NPI:1194193342
Name:BALES, KAMI (PA)
Entity Type:Individual
Prefix:
First Name:KAMI
Middle Name:
Last Name:BALES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KAMI
Other - Middle Name:
Other - Last Name:KO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2900 N INTERSTATE 35 STE 300
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-5146
Mailing Address - Country:US
Mailing Address - Phone:940-323-3480
Mailing Address - Fax:940-323-3481
Practice Address - Street 1:2900 N INTERSTATE 35 STE 300
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-5146
Practice Address - Country:US
Practice Address - Phone:940-323-3480
Practice Address - Fax:940-323-3481
Is Sole Proprietor?:No
Enumeration Date:2015-09-04
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10163363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX441071YKP5Medicare PIN