Healthcare Provider Details

I. General information

NPI: 1861100182
Provider Name (Legal Business Name): SAMANTHA NEWTON KIMBROUGH MSN, APRN, A-GNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5939 HARRY HINES BOULEVARD PROFESSIONAL OFFICE BUILDING 2, 7TH FLOOR, SUITE 700
DALLAS TX
75390-9258
US

IV. Provider business mailing address

5939 HARRY HINES BOULEVARD PROFESSIONAL OFFICE BUILDING 2, 7TH FLOOR, SUITE 700
DALLAS TX
75390-9258
US

V. Phone/Fax

Practice location:
  • Phone: 214-645-1919
  • Fax: 214-645-1903
Mailing address:
  • Phone: 214-645-1919
  • Fax: 214-645-1903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1056745
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: