Active NPI
Krista Kulesza, PHD
- Clinical Psychologist
- Southlake, TX
National Provider Identifier
1992994313
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 33605
- Practice address
- 305 Miron Dr
Southlake, TX 76092-7831 - Phone
- (682) 554-2946
- NPI assigned
- Oct 22, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 33605 | TX | Primary |
Addresses
Primary practice location
305 Miron Dr
Southlake, TX 76092-7831
Mailing address
109 W Ash LN
Euless, TX 76039-2801
Phone (469) 939-2925
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 33605 | Other | TX | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230803001805 | TX | Practitioner - Psychologist Billing Independently | 8527142694 | Practice locations: Southlake, TX |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193011200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676419200000",
"number": "1992994313",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "109 W ASH LN",
"city": "EULESS",
"state": "TX",
"postal_code": "760392801",
"telephone_number": "469-939-2925"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "305 MIRON DR",
"city": "SOUTHLAKE",
"state": "TX",
"postal_code": "760927831",
"telephone_number": "682-554-2946"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KULESZA",
"first_name": "KRISTA",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-10-22",
"last_updated": "2023-02-15",
"certification_date": "2023-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TX",
"license": "33605",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "33605",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Southlake, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.