KELLY WALTHIUS (NPI# 1922533322) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922533322 |
| Entity Type | Individual |
| Full Name | KELLY WALTHIUS |
| Credential | D.O. |
| Practice Address |
2740 N State Highway 360 Ste 100 Grand Prairie TX 75050-6402 |
| Practice Telephone | 9726068300 |
| Mailing Telephone | 9726068300 |
| Enumeration Date | 2017-04-24 |
| Last Update Date | 2020-08-31 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | S6090 | TX | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 18101 Lorain Ave, Cleveland, OH 441115612 | 2164767000 |
| Street Address |
2740 N STATE HIGHWAY 360 STE 100 |
| City | GRAND PRAIRIE |
| State | TX |
| Zip Code | 75050-6402 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225539695 | Christopher Bachman | Physical Therapy Assistant | 2045 Hwy 360, #100b, Grand Prarie, TX 75050 | 2018-02-21 |
| 1003335233 | L & B Group Home LLC | In Home Supportive Care | 605 E Palace Pkwy Ste, B4, Grand Prairie, TX 75050 | 2017-09-19 |
| 1073054748 | Smileeasy Dental Grand Prairie, Pllc | Dentist | 2650 S Hwy 161, Grand Prairie, TX 75050 | 2017-03-15 |
| 1164966651 | Prime Diagnostic Imaging of Irving, LLC | Clinic/Center | 2210 Paddock Way, Grand Prairie, TX 75050 | 2016-12-19 |
| 1366801037 | Monica Simpson | Counselor | 2080 N Hwy 360, Ste 430, Grand Prairie, TX 75050 | 2016-02-23 |
| 1437545845 | Stateserv Medical of Texas | Durable Medical Equipment & Medical Supplies | 1000 Post and Paddock Street, #305, Grand Prairie, TX 75050 | 2015-04-13 |
| 1912304593 | Tenishia Chintankwa | Non-emergency Medical Transport (VAN) | 2403 Doreen St, Grand Prairie, TX 75050 | 2014-11-26 |
| 1780023192 | Holland Surgical Group | Physician Assistant | 201 West Tarrant Rd. #1420, Grand Prairie, TX 75050 | 2013-06-19 |
| 1174962823 | Occumed Plus-grand Prairie | General Practice | 805 W. North Carrier Pkwy, 260, Grand Prairie, TX 75050 | 2013-06-17 |
| 1497099618 | Sorai Susanne S Stuart | Counselor | 2825 N. State Hwy 360, 710, Grand Prairie, TX 75050 | 2012-11-15 |
| Find all providers in zip 75050 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427673375 | Imd Healthcare Association, Inc. | Family Medicine | 5857 Tory Dr, Grand Prairie, TX 75052-8500 | 2020-06-16 |
| 1134686926 | Grand Prairie Physician Group LLC | Family Medicine | 517 N Carrier Pkwy Ste J, Grand Prairie, TX 75050-5484 | 2019-02-27 |
| 1699158964 | Gp Medical Management Group Inc | Family Medicine | 2634 S Carrier Pkwy Ste 105, Grand Prairie, TX 75052-5005 | 2015-07-06 |
| 1407237316 | Bethany Wimberly | Family Medicine | 3095 Kingswood Blvd Ste 250, Grand Prairie, TX 75052 | 2015-06-16 |
| 1285047514 | Shaun Gould | Family Medicine | 2740 N Hwy 360 Ste 100, Grand Prairie, TX 75050-6402 | 2014-06-04 |
| 1841543097 | Omni Pain Clinic Inc | Family Medicine | 513 W Jefferson Blvd., Suite 170, Grand Prairie, TX 75051-1639 | 2012-10-24 |
| 1013238401 | Ahmad Ghassan Abazid | Family Medicine | 4927 Lake Ridge Pkwy Ste 100, Grand Prairie, TX 75052 | 2010-06-20 |
| 1912157819 | Cynthia Denise Mckinney | Family Medicine | 2520 W Interstate 20, Grand Prairie, TX 75052-7280 | 2008-09-26 |
| 1164697850 | Crystal Renee Foster | Family Medicine | 4927 Lakeridge Pkwy, Suite 100, Grand Prairie, TX 75052-3087 | 2008-04-24 |
| 1932395514 | Nahn Ta | Family Medicine | 5047 Barcelona Trl, Grand Prairie, TX 75052-0937 | 2007-09-18 |
| Find all providers in GRAND PRAIRIE | ||||
| City | GRAND PRAIRIE |
| Zip Code | 75050 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.