Healthcare Provider Details

I. General information

NPI: 1811411242
Provider Name (Legal Business Name): KIMBERLY ANN JOHNSON-HAMILTON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2017
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14841 DALLAS PKWY STE 450
DALLAS TX
75254-8035
US

IV. Provider business mailing address

14841 DALLAS PKWY STE 450
DALLAS TX
75254-8035
US

V. Phone/Fax

Practice location:
  • Phone: 469-547-1700
  • Fax: 469-420-5362
Mailing address:
  • Phone: 469-547-1700
  • Fax: 469-420-5362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP133801
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP133801
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: