Provider Demographics
NPI:1457828733
Name:KENDRA M. BREITHAUPT, RN, FNP, PLLC
Entity Type:Organization
Organization Name:KENDRA M. BREITHAUPT, RN, FNP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-592-0281
Mailing Address - Street 1:2106 ROCK WOOD LN
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75072-5444
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:214-592-0839
Practice Address - Street 1:6331 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-3938
Practice Address - Country:US
Practice Address - Phone:214-821-6331
Practice Address - Fax:214-821-6332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1942454632OtherINDIVIDUAL NPI