Healthcare Provider Details

I. General information

NPI: 1376089318
Provider Name (Legal Business Name): KIMBERLY HALL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2017
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 MEDICAL CENTER BLVD STE 100
CONROE TX
77304-2928
US

IV. Provider business mailing address

395 WESTLAKE TERRACE DR
CONROE TX
77304-3125
US

V. Phone/Fax

Practice location:
  • Phone: 936-788-1060
  • Fax: 936-788-2844
Mailing address:
  • Phone: 314-630-2212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP132943
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: