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General NPI Number Information
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NPI Number | 1922081744
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Entity Type | Individual
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Provider Name | KIMBERLY WOODS SHIPPER PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/25/2005
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Last Update Date | 09/08/2009
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Provider Practice Location Address
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Address Line | 100 MEMORIAL DRIVE
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City | HUNTSVILLE
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State | TX
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Zip | 77340
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Country | US
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Telephone | 936-291-4589
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9072
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City | HUNTSVILLE
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State | TX
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Zip | 77340-0018
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Country | US
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Telephone | 936-348-5039
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA04565
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License Number State | TX
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