Provider Demographics
NPI:1326127952
Name:MCKINZEY, DIMPLE MARTIN (ACA)
Entity Type:Individual
Prefix:
First Name:DIMPLE
Middle Name:MARTIN
Last Name:MCKINZEY
Suffix:
Gender:F
Credentials:ACA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26222 RR 12
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-4903
Mailing Address - Country:US
Mailing Address - Phone:512-858-0300
Mailing Address - Fax:512-858-2714
Practice Address - Street 1:302 E LOOP 281
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-7912
Practice Address - Country:US
Practice Address - Phone:903-381-4044
Practice Address - Fax:903-381-4045
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX50491237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1528945-01Medicaid