MEDICARE: ANTOINETTE KIMERER ANDERSON CNM

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	176B00000X	Midwife	439129	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	439129	OTHER	TN	LICENSE
4	86N732	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1679655567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTOINETTE KIMERER ANDERSON CNM

Provider Business Mailing Address
First Line	:	5737 CULLEN BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77021-1665
Country	:	US
Telephone Number	:	813-440-7313
Fax Number	:

Provider Business Practice Location Address
First Line	:	5737 CULLEN BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77021-1665
Country	:	US
Telephone Number	:	813-440-7313
Fax Number	:

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	06/16/2015

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