MEDICARE: MRS. KIMBERLY ANN GRIFFITH RN, ACNP-BC

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	363LA2100X	Acute Care Nurse Practitioner	558761	TX

General Provider Information

NPI Number	:	1033541123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY ANN GRIFFITH RN, ACNP-BC

Provider Business Mailing Address
First Line	:	4105 JUNIUS ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-1428
Country	:	US
Telephone Number	:	214-824-2744
Fax Number	:	214-823-9951

Provider Business Practice Location Address
First Line	:	4105 JUNIUS ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-1428
Country	:	US
Telephone Number	:	214-824-2744
Fax Number	:	214-823-9951

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

Provider Enumeration Date	:	07/31/2013
Last Update Date	:	07/31/2013

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