Provider Demographics
NPI:1497148613
Name:FARLEY, KARA CHARLOTTE
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:CHARLOTTE
Last Name:FARLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:CHARLOTTE
Other - Last Name:KLOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1501 HUGHES RD STE 103
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-7452
Mailing Address - Country:US
Mailing Address - Phone:817-284-9875
Mailing Address - Fax:
Practice Address - Street 1:1501 HUGHES RD STE 103
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-7452
Practice Address - Country:US
Practice Address - Phone:817-284-9875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-12
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ9605171000000X, 207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No171000000XOther Service ProvidersMilitary Health Care Provider
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program