Healthcare Provider Details

I. General information

NPI: 1033036355
Provider Name (Legal Business Name): KIMBERLY ALICE KIDNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 N TERRY ST STE B
MALAKOFF TX
75148-9669
US

IV. Provider business mailing address

214 N TERRY ST STE B
MALAKOFF TX
75148-9669
US

V. Phone/Fax

Practice location:
  • Phone: 903-489-7014
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-245291
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: