Healthcare Provider Details

I. General information

NPI: 1811454044
Provider Name (Legal Business Name): KIMBERLY FORDHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2019
Last Update Date: 10/10/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3307 SPRING STUEBNER RD STE D
SPRING TX
77389-4690
US

IV. Provider business mailing address

3301 SPRING STUEBNER RD STE 110
SPRING TX
77389-5195
US

V. Phone/Fax

Practice location:
  • Phone: 346-800-6001
  • Fax:
Mailing address:
  • Phone: 346-800-6001
  • Fax: 346-800-6002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number203684
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: