Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | Q8609 | TX |
N | 208000000X | Pediatrician | 263989 | NY |
Y | 2080P0204X | Pediatric Emergency Doctor | Q8609 | TX |
NPI | 1639488786 |
---|---|
Provider Name | Kellie Quinn |
First Address | Dallas, TX 75284-4658 |
Second Address | Temple, TX 76502-1814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2010 |
Last Update Date | 19/01/2021 |