North East Texas Mid-Level Assist

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA03242 Issued in TX

Legal business name

NORTH EAST TEXAS MID-LEVEL ASSIST

Practice address

809 W Harwood Rd Ste 101
Hurst, TX 76054-3293

Phone

(817) 283-5252

Fax

(817) 283-5283

NPI assigned

Mar 20, 2015

Last updated

Mar 20, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Larry M Kjeldgaard, D.O,

Title

Sole Member

Phone

(817) 283-5252

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1426809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426809600000",
    "number": "1356735047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 W HARWOOD RD STE 101",
            "city": "HURST",
            "state": "TX",
            "postal_code": "760543293",
            "telephone_number": "817-283-5252",
            "fax_number": "817-283-5283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "809 W HARWOOD RD STE 101",
            "city": "HURST",
            "state": "TX",
            "postal_code": "760543293",
            "telephone_number": "817-283-5252",
            "fax_number": "817-283-5283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH EAST TEXAS MID-LEVEL ASSIST",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-20",
        "last_updated": "2015-03-20",
        "status": "A",
        "authorized_official_last_name": "KJELDGAARD",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "817-283-5252",
        "authorized_official_credential": "D.O,"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TX",
            "license": "PA03242",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nightingale of Houston, Inc (Nightingale Home Healthcare of North Texas)
• Nocona Hospital District (Oakmont Guest Care Center LLC)
• Nordstrom Inc & Subsidiaries
• North Central Texas Spine Institute
• North East Texas Mid-Level Assist
• North Texas Family Care, PLLC
• Northeast Tarrant Dermatology, Inc
• Jerome Douglas Novotny Jr., M.D.
• Michaela Sydney Nowlin, CCC/SLP
• Noxi Medical

• Surgical Physician Assistant in Hurst, TX
• Providers in Hurst, TX by specialty
• Surgical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.