Healthcare Provider Details

I. General information

NPI: 1396126116
Provider Name (Legal Business Name): JANA KIMBERLIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANA LAWRENCE

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4421 HIGHWAY 6 S STE 100
COLLEGE STATION TX
77845-6176
US

IV. Provider business mailing address

1500 UNIVERSITY DR E #100
COLLEGE STATION TX
77840-2600
US

V. Phone/Fax

Practice location:
  • Phone: 979-731-5200
  • Fax: 979-731-5210
Mailing address:
  • Phone: 979-846-1100
  • Fax: 979-260-9390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number764222
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: