Provider Demographics
NPI:1326361882
Name:CABALLERO, KRISTINA MCKINLEY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:MCKINLEY
Last Name:CABALLERO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 HARRY HINES BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TEXAS
Mailing Address - Zip Code:75214
Mailing Address - Country:UM
Mailing Address - Phone:817-507-0794
Mailing Address - Fax:817-507-0795
Practice Address - Street 1:7208 MEADOW LAKE AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-3526
Practice Address - Country:US
Practice Address - Phone:508-737-7202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06645363A00000X, 363AM0700X, 363AS0400X
MAPA6103363A00000X
COPA.0006174363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA06645OtherLICENSE