Healthcare Provider Details

I. General information

NPI: 1871129791
Provider Name (Legal Business Name): KIMBERLY FERNANDEZ TRAHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY FERNANDEZ

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 FOREST LN
DALLAS TX
75230-2571
US

IV. Provider business mailing address

1121 E SPRING CREEK PKWY STE 110
PLANO TX
75074-3098
US

V. Phone/Fax

Practice location:
  • Phone: 214-343-6663
  • Fax: 214-343-2814
Mailing address:
  • Phone: 214-343-6663
  • Fax: 214-343-2814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberW5331
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberW5331
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: