Provider Demographics
NPI:1376652123
Name:KINRA, AGNES KIRKLAND (MD)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:KIRKLAND
Last Name:KINRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2130207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y688Medicare PIN
TXF84125Medicare UPIN