Healthcare Provider Details

I. General information

NPI: 1861882995
Provider Name (Legal Business Name): KRISTINA RENEE FIMBRES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 E HEBRON PKWY SUITE 200
CARROLLTON TX
75010
US

IV. Provider business mailing address

2416 FOX GLENN CIR
BEDFORD TX
76021-2671
US

V. Phone/Fax

Practice location:
  • Phone: 469-464-5133
  • Fax:
Mailing address:
  • Phone: 817-975-9932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA09928
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: