Provider Demographics
NPI:1043052566
Name:STRUVE, KAIRAH JERNAY
Entity type:Individual
Prefix:
First Name:KAIRAH
Middle Name:JERNAY
Last Name:STRUVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 CAVALIER PL
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-6013
Mailing Address - Country:US
Mailing Address - Phone:817-480-6301
Mailing Address - Fax:
Practice Address - Street 1:201 REGENCY PKWY
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5638
Practice Address - Country:US
Practice Address - Phone:682-400-0305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9X8G9Q2202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology