Provider Demographics
NPI:1649755356
Name:RUIZ, KYNDRA (NP)
Entity Type:Individual
Prefix:
First Name:KYNDRA
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1934 STARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-6155
Mailing Address - Country:US
Mailing Address - Phone:940-682-5959
Mailing Address - Fax:
Practice Address - Street 1:11797 SOUTH FWY STE 254
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7035
Practice Address - Country:US
Practice Address - Phone:817-293-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138960363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily