Provider Demographics
NPI:1548281801
Name:KALLENBACH-WATSON, BARBARA LYNN (CNP)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:LYNN
Last Name:KALLENBACH-WATSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:LYNN
Other - Last Name:KALLENBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7979 W VIRGINIA DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3798
Mailing Address - Country:US
Mailing Address - Phone:972-780-8400
Mailing Address - Fax:972-656-0380
Practice Address - Street 1:7979 W VIRGINIA DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3798
Practice Address - Country:US
Practice Address - Phone:972-780-8400
Practice Address - Fax:972-656-0380
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX738831363LA2200X
TXAP115786363LA2200X
MI4704123646363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184944003Medicaid
TX184944004Medicaid
TX184944002Medicaid
TX184944003Medicaid
TXTXB102644Medicare PIN
TXTXB102643Medicare PIN