MEDICARE: KIMBERLY NICOLE CRITTENDEN M.D.

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	207V00000X	Obstetrics & Gynecology Physician	M3200	TX

General Provider Information

NPI Number	:	1033160593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY NICOLE CRITTENDEN M.D.

Provider Business Mailing Address
First Line	:	2542 BABCOCK RD
Second Line	:	A202
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-6304
Country	:	US
Telephone Number	:	210-949-1405
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 BROOKLYN AVE
Second Line	:	SUITE 220
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-4803
Country	:	US
Telephone Number	:	210-228-0705
Fax Number	:

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	07/08/2007

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