Provider Demographics
NPI:1285831404
Name:LINK, DENISE KELLER (PA-C, MPAS, FNKF)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:KELLER
Last Name:LINK
Suffix:
Gender:F
Credentials:PA-C, MPAS, FNKF
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:MARIE
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7208
Mailing Address - Country:US
Mailing Address - Phone:214-645-6416
Mailing Address - Fax:214-645-6272
Practice Address - Street 1:5939 HARRY HINES BLVD SUITE 700
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390
Practice Address - Country:US
Practice Address - Phone:214-645-6416
Practice Address - Fax:214-645-1945
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04947363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187719301Medicaid
TX8J7905Medicare UPIN