MEDICARE: EVA KIMBLE RN, CMGT-BC, IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0400X	Case Management Registered Nurse	774505	TX
2	163WL0100X	Lactation Consultant (Registered Nurse)	774505	TX

General Provider Information

NPI Number	:	1174465264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVA KIMBLE RN, CMGT-BC, IBCLC

Provider Business Mailing Address
First Line	:	342 LOUISIANA AVE
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78404-1706
Country	:	US
Telephone Number	:	210-792-2594
Fax Number	:

Provider Business Practice Location Address
First Line	:	342 LOUISIANA AVE
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78404-1706
Country	:	US
Telephone Number	:	210-792-2594
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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