Provider Demographics
NPI:1801411277
Name:WILLDEN, KARA MARIE
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:MARIE
Last Name:WILLDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6503 W SHADY SHORES RD APT 717
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-5565
Mailing Address - Country:US
Mailing Address - Phone:940-867-8693
Mailing Address - Fax:
Practice Address - Street 1:240 E RENFRO ST STE 204
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-3940
Practice Address - Country:US
Practice Address - Phone:817-968-5756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-11
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145289363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty