MEDICARE: MS. KIMBERLY SUE WOLF FNPC

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	363LF0000X	Family Nurse Practitioner	559589	TX

General Provider Information

NPI Number	:	1285628610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY SUE WOLF FNPC

Provider Business Mailing Address
First Line	:	9330 LBJ FWY STE 800
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-4310
Country	:	US
Telephone Number	:	972-792-5700
Fax Number	:	214-506-1170

Provider Business Practice Location Address
First Line	:	730 E ELDORADO PKWY
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-5444
Country	:	US
Telephone Number	:	972-292-3330
Fax Number	:	972-292-3332

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

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	12/03/2020

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