MEDICARE: KIMBERLY ANNE EAGLETON N.P., R.N.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	455845	TX

General Provider Information

NPI Number	:	1033151188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ANNE EAGLETON N.P., R.N.C.

Provider Business Mailing Address
First Line	:	9003 AIRPORT FWY
Second Line	:	SUITE 300
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-7770
Country	:	US
Telephone Number	:	817-514-5200
Fax Number	:	817-514-5210

Provider Business Practice Location Address
First Line	:	209 N BONNIE BRAE ST
Second Line	:	SUITE 304
City	:	DENTON
State	:	TX
Zip	:	76201-3708
Country	:	US
Telephone Number	:	940-898-1476
Fax Number	:	940-381-0188

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	10/11/2007

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