Provider Demographics
NPI:1376089318
Name:HALL, KIMBERLY (NP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 WESTLAKE TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3125
Mailing Address - Country:US
Mailing Address - Phone:314-630-2212
Mailing Address - Fax:
Practice Address - Street 1:503 MEDICAL CENTER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2928
Practice Address - Country:US
Practice Address - Phone:936-788-1060
Practice Address - Fax:936-788-2844
Is Sole Proprietor?:No
Enumeration Date:2017-01-15
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132943363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily