Kallal Bros, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

KALLAL BROS, LLC

Practice address

400 S Oak St Ste 120
Roanoke, TX 76262-6789

Phone

(817) 900-0304

Fax

(817) 900-0432

NPI assigned

Nov 20, 2018

Organization subpart

No

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

Authorized official

Name

John Kallal

Title

Member

Phone

(817) 915-1520

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• RISE Men's Health Doing business as

Locations

Practitioners 2

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

• Jessica Marie Zimmer, PA-C

  • Physician Assistant
  • Roanoke, TX
  • NPI 1124563671
  NPD
• Kenneth Douglas Lecroy, M.D.

  • Family Medicine Physician
  • Colleyville, TX
  • NPI 1598848830
  NPD (past)

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

{
    "created_epoch": "1542672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744675200000",
    "number": "1780153734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 S OAK ST STE 120",
            "city": "ROANOKE",
            "state": "TX",
            "postal_code": "762626789",
            "telephone_number": "817-900-0304",
            "fax_number": "817-900-0432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S OAK ST STE 120",
            "city": "ROANOKE",
            "state": "TX",
            "postal_code": "762626789",
            "telephone_number": "817-900-0304",
            "fax_number": "817-900-0432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KALLAL BROS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-20",
        "last_updated": "2025-04-15",
        "certification_date": "2025-04-15",
        "status": "A",
        "authorized_official_last_name": "KALLAL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "817-915-1520"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "H7766",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RISE Men's Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "RISE Men's Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Morgan Elizabeth Johnson, DMD
• Shakeara Latoya Johnson, FNP-C
• Jostcare Behavioral Health Services PLLC
• Joy-Filled Counseling, PLLC
• Jude'S Place LLC
• Judy Karrenbrock, LPT
• Kelly Harrelson DDS, PLLC
• Hillery Gabrielle Key, CST/CSFA
• Kharis Eye Care PLLC
• Kimberley a Baker, DDS, PA

• All providers in Roanoke, TX
• Primary Care Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2025; 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.