Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | P8482 | TX |
Y | 207QS0010X | Family Doctor - Sports Medicine | P8482 | TX |
NPI | 1033418207 |
---|---|
Provider Name | Krystle R Farmer |
First Address | Dallas, TX 75373-3784 |
Second Address | Fort Worth, TX 76104-2710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2011 |
Last Update Date | 21/04/2021 |