National Provider Identifier Database

FOREVER KIDS PEDIATRIC CLINIC
Clinic/Center

A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).


Contact Information

FOREVER KIDS PEDIATRIC CLINIC
20783 INTERSTATE 20 SOUTH ACCESS ROAD
CANTON, TX75103
Phone: 214-773-5669
Fax: 844-678-6258
Website:
Specialty Taxonomy Code
* Clinic/Center 261Q00000X
Primary Care 261QP2300X

* Indicates primary specialty

NPI Profile & details for FOREVER KIDS PEDIATRIC CLINIC

NPI Number 1326435199
Legal business name
LBN
FOREVER KIDS PEDIATRIC CLINIC
Authorized official LACY BURKES - (PEDIATRIC NURSE PRACTITIONER)
Entity Organization
Organization subpart No
Enumeration date 04/20/2015
Last updated 01/26/2023 - About 3 years ago
Sole proprietor1 Not specified
Identifiers
  • TX License #: 754047
  • TX Medicaid: 1349815603
  • TX Other: 1750646279 NPI

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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