Healthcare Provider Details

I. General information

NPI: 1750612792
Provider Name (Legal Business Name): KIMBERLY ANNE SAKOVICH WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2010
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 N MACARTHUR BLVD SUITE 500
IRVING TX
75062-3651
US

IV. Provider business mailing address

3501 N MACARTHUR BLVD SUITE 500
IRVING TX
75062-3651
US

V. Phone/Fax

Practice location:
  • Phone: 972-256-3700
  • Fax: 972-258-9887
Mailing address:
  • Phone: 972-256-3700
  • Fax: 972-258-9887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number658263
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: