Provider Demographics
NPI:1265949168
Name:REICH, KENZIE (APRN, AGCNS-BC)
Entity type:Individual
Prefix:
First Name:KENZIE
Middle Name:
Last Name:REICH
Suffix:
Gender:F
Credentials:APRN, AGCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4012 BOYD AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4546
Mailing Address - Country:US
Mailing Address - Phone:970-420-7906
Mailing Address - Fax:
Practice Address - Street 1:4012 BOYD AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4546
Practice Address - Country:US
Practice Address - Phone:970-420-7906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135620364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP135620OtherTEXAS BOARD OF NURSING APRN LICENSE