MEDICARE: KIMBERLY BLASINI NP

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	363LW0102X	Women's Health Nurse Practitioner	AP137901	TX

General Provider Information

NPI Number	:	1376039297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY BLASINI NP

Provider Business Mailing Address
First Line	:	5477 GLEN LAKES DR STE 200
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4381
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5477 GLEN LAKES DR STE 200
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4381
Country	:	US
Telephone Number	:	214-363-5965
Fax Number	:

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

Provider Enumeration Date	:	07/03/2018
Last Update Date	:	02/26/2025

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