Pediatric Kare Klinic PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

PEDIATRIC KARE KLINIC PLLC

Practice address

104 E US Highway 80 Ste 190
Forney, TX 75126-8615

Phone

(469) 602-5277

Fax

(469) 995-7898

NPI assigned

Dec 17, 2018

Organization subpart

No

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

Authorized official

Name

Mrs. Deloris Renee Harwell, APRN, MSN, CPNP-PCNPI 1346478252

Title

Pediatric Nurse Practitioner

Phone

(469) 602-5277

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Deloris Renee Harwell, PNP-PC

  • Pediatric Nurse Practitioner
  • Forney, TX
  • NPI 1346478252
  Medicare reassignment NPD Authorized official
• Megan Marie Sikes, APRN

  • Nurse Practitioner
  • Forney, TX
  • NPI 1508591033
  NPD

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

{
    "created_epoch": "1545004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583971200000",
    "number": "1609348580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 E US HIGHWAY 80 STE 190",
            "city": "FORNEY",
            "state": "TX",
            "postal_code": "751268615",
            "telephone_number": "469-602-5277",
            "fax_number": "469-995-7898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 E US HIGHWAY 80 STE 190",
            "city": "FORNEY",
            "state": "TX",
            "postal_code": "751268615",
            "telephone_number": "469-602-5277",
            "fax_number": "469-995-7898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC KARE KLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-17",
        "last_updated": "2020-03-12",
        "certification_date": "2020-03-12",
        "status": "A",
        "authorized_official_last_name": "HARWELL",
        "authorized_official_first_name": "DELORIS",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "PEDIATRIC NURSE PRACTITIONER",
        "authorized_official_telephone_number": "469-602-5277",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "APRN, MSN, CPNP-PC"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "407416301",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS HEALTH STEPS",
            "identifier": "407416302",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Amanda Paige Pearson, M.A., LPC ASSOCIATE
• Kristin Pendrich
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• Gaetano R. Perilli
• Kirsten Marie Perilli, LPC-ASSOCIATE
• Christie Dianne Perkins, RPH

• Primary Care Clinic/Center in Forney, TX
• Providers in Forney, TX by specialty
• Primary Care Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.