MEDICARE: MS. KIMBERLY KATHRYN KINSELLA RN

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	163W00000X	Registered Nurse	458968	TX

General Provider Information

NPI Number	:	1104023431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY KATHRYN KINSELLA RN

Provider Business Mailing Address
First Line	:	14258 FM 2769
Second Line	:
City	:	VOLENTE
State	:	TX
Zip	:	78641-9130
Country	:	US
Telephone Number	:	512-219-0949
Fax Number	:

Provider Business Practice Location Address
First Line	:	14258 FM 2769
Second Line	:
City	:	VOLENTE
State	:	TX
Zip	:	78641-9130
Country	:	US
Telephone Number	:	512-219-0949
Fax Number	:

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

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	07/08/2007

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