Provider Demographics
NPI:1013448604
Name:PERRYMAN, KASHIRIS WALTON (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KASHIRIS
Middle Name:WALTON
Last Name:PERRYMAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 CLEARFORK MAIN ST STE 430
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3559
Mailing Address - Country:US
Mailing Address - Phone:817-984-1688
Mailing Address - Fax:
Practice Address - Street 1:5450 CLEARFORK MAIN ST STE 430
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-3559
Practice Address - Country:US
Practice Address - Phone:817-984-1688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133637363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily