Provider Demographics
NPI:1952403412
Name:KINSFATHER, TERESA HILL (DO)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:HILL
Last Name:KINSFATHER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 S MAIN ST
Mailing Address - Street 2:P.O.BOX 390
Mailing Address - City:GIDDINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78942-4118
Mailing Address - Country:US
Mailing Address - Phone:979-542-4357
Mailing Address - Fax:979-542-1010
Practice Address - Street 1:514 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GIDDINGS
Practice Address - State:TX
Practice Address - Zip Code:78942-4118
Practice Address - Country:US
Practice Address - Phone:979-542-4357
Practice Address - Fax:979-542-1010
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6181207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1538410956OtherORGANIZATION NPI
TX742606115OtherTIN
TX1538410956OtherORGANIZATION NPI