Provider Demographics
NPI:1851320527
Name:KLEIN, CONNIE L (NP)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:L
Last Name:KLEIN
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:PO BOX 301173
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75303-1173
Mailing Address - Country:US
Mailing Address - Phone:713-500-3500
Mailing Address - Fax:
Practice Address - Street 1:1776 YORKTOWN ST
Practice Address - Street 2:150
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-4182
Practice Address - Country:US
Practice Address - Phone:713-572-8122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX638721363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N4450OtherBCBS
TX160591701Medicaid
TX8B1450Medicare PIN
TX8N4450OtherBCBS
TXP00108606Medicare PIN