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General NPI Number Information
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NPI Number | 1689323933
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Entity Type | Individual
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Provider Name | KIMBERLY LAMAR BONASSIN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 03/23/2022
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 5511 GLADEHILL DR
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City | HUMBLE
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State | TX
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Zip | 77345-2453
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Country | US
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Telephone | 512-947-7402
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Fax |
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Provider Business Mailing Address
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Address Line | 11511 SHADOW CREEK PARKWAY HR/CREDENTIALING SERVICES
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City | PEARLAND
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State | TX
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Zip | 77584-7298
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Country | US
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Telephone | 713-442-0000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 781598
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1089044
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License Number State | TX
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