Facts
- Status
- A
- Credential
- RNFA
- Type
- Individual
- Enumeration date
- 2023-08-29
- Last updated
- 2026-06-26
Licenses
- License MO
- 2008029501
Location
- Practice location
- 2796 KINGS CROSSING DR
- City
- BARNHART MO
- Postal code
- 630121174
- Phone
- 214-227-2457
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.