Kevin J Kallal MD PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

H7766 Issued in TX

Legal business name

KEVIN J KALLAL MD PA

Practice address

240 N Rufe Snow Dr
Keller, TX 76248-4226

Phone

(817) 431-0606

Fax

(817) 379-0155

NPI assigned

Mar 10, 2008

Organization subpart

No

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

Authorized official

Name

Kevin J Kallal, M.D.

Title

Owner/President

Phone

(817) 431-0606

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kallal Medical Group Doing business as

Locations

Practitioners 4

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

• Ivonne Braxton, FNP-BC

  • Family Nurse Practitioner
  • Fort Worth, TX
  • NPI 1720374515
  NPD (past)
• Christine Michelle Kratch, FNP-C

  • Family Nurse Practitioner
  • Colleyville, TX
  • NPI 1891316030
  NPD (past)
• Jill Sarah Rowland, PA-C

  • Physician Assistant
  • Keller, TX
  • NPI 1659800449
  NPD (past)
• Mary P Van Hal, MD

  • Internal Medicine Physician
  • Keller, TX
  • NPI 1902976442
  NPD (past)

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

{
    "created_epoch": "1205107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576713600000",
    "number": "1891965505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5015 FORT AVE",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767105828",
            "telephone_number": "817-431-0606",
            "fax_number": "817-379-0155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 N RUFE SNOW DR",
            "city": "KELLER",
            "state": "TX",
            "postal_code": "762484226",
            "telephone_number": "817-431-0606",
            "fax_number": "817-379-0155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEVIN J KALLAL MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-10",
        "last_updated": "2019-12-19",
        "certification_date": "2019-12-19",
        "status": "A",
        "authorized_official_last_name": "KALLAL",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "817-431-0606",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "H7766",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1861408205",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kallal Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kallal Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gay S Kelso, LCSW
• Sharidyn Kelton
• Olivia Kendall
• Kenneth Archer MD PA
• Sara Kercho
• Kfcapa
• Abu Baker Azeem Khan, PHARMD
• Safeera Khan, DMD
• Liza Abigail Copuyoc Khou, OTR
• Khadijah Kidd

• Family Medicine Physician in Keller, TX
• Providers in Keller, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2019; 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.