Healthcare Provider Details

I. General information

NPI: 1053772053
Provider Name (Legal Business Name): KIM ANDREWS CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2016
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1872 N LAKE FOREST DR
MCKINNEY TX
75071-7665
US

IV. Provider business mailing address

PO BOX 733784
DALLAS TX
75373-3784
US

V. Phone/Fax

Practice location:
  • Phone: 972-548-0758
  • Fax:
Mailing address:
  • Phone: 682-885-6163
  • Fax: 682-885-1396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP130557
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP130557
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: