Basic Information
| Provider Information | |||||||||
| NPI: | 1114160397 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KINNEAR | ||||||||
| FirstName: | REAGAN | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RINDERKNECHT | ||||||||
| OtherFirstName: | REAGAN | ||||||||
| OtherMiddleName: | LYNN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PH.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1300 W LANCASTER AVE | ||||||||
| Address2: | PATIENT ACCOUNTING | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761023410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173368611 | ||||||||
| FaxNumber: | 8173902961 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 W LANCASTER AVE | ||||||||
| Address2: | PATIENT ACCOUNTING | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761023410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173368611 | ||||||||
| FaxNumber: | 8173902961 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2009 | ||||||||
| LastUpdateDate: | 10/25/2016 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 04509 | MD | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.