Provider Demographics
NPI:1336899368
Name:KINDALL, EMILY (MD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:KINDALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5348 S SUGAR RD APT 5202
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-0270
Mailing Address - Country:US
Mailing Address - Phone:480-292-0914
Mailing Address - Fax:
Practice Address - Street 1:5501 S MCCOLL RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-5503
Practice Address - Country:US
Practice Address - Phone:480-292-0914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10086187390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBP10086187OtherLICENSE NUMBER (TMB PHYSICIAN IN TRAINING PERMIT)