Provider Demographics
NPI:1912568908
Name:KALALA, KASIMU FRANK (FNP)
Entity type:Individual
Prefix:
First Name:KASIMU
Middle Name:FRANK
Last Name:KALALA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3902 IMPATIENS VW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-2961
Mailing Address - Country:US
Mailing Address - Phone:210-307-5387
Mailing Address - Fax:
Practice Address - Street 1:US 191 & AZ 264
Practice Address - Street 2:
Practice Address - City:GANADO
Practice Address - State:AZ
Practice Address - Zip Code:86505
Practice Address - Country:US
Practice Address - Phone:928-755-4632
Practice Address - Fax:928-755-4831
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142884363LF0000X
AZ234713363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily