Healthcare Provider Details

I. General information

NPI: 1417574278
Provider Name (Legal Business Name): KIMBERLY ANN JUSTICE APRN, MSN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2020
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 N FRAZIER ST STE 102-F10
CONROE TX
77301-1239
US

IV. Provider business mailing address

1915 N FRAZIER ST STE 102-F10
CONROE TX
77301-1239
US

V. Phone/Fax

Practice location:
  • Phone: 806-591-4117
  • Fax: 806-214-3417
Mailing address:
  • Phone: 806-591-4117
  • Fax: 806-214-3417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1033630
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN-80801
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number60947
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: