MEDICARE: NANCY LEONA KIMBROW M. D.

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	207Q00000X	Family Medicine Physician	G4148	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295799880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY LEONA KIMBROW M. D.

Provider Business Mailing Address
First Line	:	212 S OLD BETSY RD
Second Line	:
City	:	KEENE
State	:	TX
Zip	:	76059-2427
Country	:	US
Telephone Number	:	817-641-8141
Fax Number	:	817-558-2305

Provider Business Practice Location Address
First Line	:	212 S OLD BETSY RD
Second Line	:
City	:	KEENE
State	:	TX
Zip	:	76059-2427
Country	:	US
Telephone Number	:	817-641-8141
Fax Number	:	817-558-2305

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

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	02/23/2010

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