Healthcare Provider Details

I. General information

NPI: 1598964009
Provider Name (Legal Business Name): MICHELLE K. KIMBALL ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE K. JONES-KIMBALL ANP

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W TERRELL #500
FT. WORTH TX
76104-2810
US

IV. Provider business mailing address

1300 W. TERRELL #500 CONSULTANTS IN CARDIOLOGY, PA
FT. WORTH TX
76104-2810
US

V. Phone/Fax

Practice location:
  • Phone: 817-252-5000
  • Fax: 817-252-5060
Mailing address:
  • Phone: 817-252-5000
  • Fax: 817-252-5060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP107871
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: