MEDICARE: KIMBERLY R BOOKOUT DNP, RN, CPNP

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	363LP0200X	Pediatric Nurse Practitioner	558572	TX

General Provider Information

NPI Number	:	1932208709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY R BOOKOUT DNP, RN, CPNP

Provider Business Mailing Address
First Line	:	4335 WINDSOR CENTRE TRL # 130
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-1859
Country	:	US
Telephone Number	:	214-392-3070
Fax Number	:

Provider Business Practice Location Address
First Line	:	4305 WINDSOR CENTRE TRL
Second Line	:	300
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-1864
Country	:	US
Telephone Number	:	972-355-7900
Fax Number	:	972-355-7922

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	08/15/2019

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