Provider Demographics
NPI:1871900183
Name:KRAMER, KARA MICHELLE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:MICHELLE
Last Name:KRAMER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:MICHELLE
Other - Last Name:DONOVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4224 PARK SPRINGS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-4729
Mailing Address - Country:US
Mailing Address - Phone:817-467-7474
Mailing Address - Fax:817-468-8643
Practice Address - Street 1:4224 PARK SPRINGS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-4729
Practice Address - Country:US
Practice Address - Phone:817-467-7474
Practice Address - Fax:817-468-8643
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0814519363LP0808X, 363L00000X
TXAP131961363LF0000X
KS53-76472-121363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201103390BMedicaid
003719364OtherMEDICARE