Provider Demographics
NPI:1275719122
Name:AGNES KINRA MD, PA
Entity Type:Organization
Organization Name:AGNES KINRA MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:
Authorized Official - Last Name:KINRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-596-0006
Mailing Address - Street 1:4104 W 15TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5860
Mailing Address - Country:US
Mailing Address - Phone:972-596-0006
Mailing Address - Fax:972-596-0904
Practice Address - Street 1:4104 W 15TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5860
Practice Address - Country:US
Practice Address - Phone:972-596-0006
Practice Address - Fax:972-596-0904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2130261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF84125Medicare UPIN
TX00Y688Medicare PIN