Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 1913 | TX |
Y | 222Z00000X | Podiatrist | 1913 | TX |
N | 224P00000X | Prosthetist | 1913 | TX |
NPI | 1033752555 |
---|---|
Provider Name | Kristiana Rhae Kiessling |
First Address | Dallas, TX 75219-3924 |
Second Address | Dallas, TX 75219-3924 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2019 |
Last Update Date | 28/10/2019 |