MEDICARE: KIMBERLY ANN JUSTICE APRN, MSN, PMHNP-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	163WP0808X	Psychiatric/Mental Health Registered Nurse	RN-80801	NM
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	60947	NM
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1033630	TX

General Provider Information

NPI Number	:	1417574278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ANN JUSTICE APRN, MSN, PMHNP-BC

Provider Business Mailing Address
First Line	:	6900 W I 40 STE 180
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79106-2522
Country	:	US
Telephone Number	:	806-738-3456
Fax Number	:	806-214-3417

Provider Business Practice Location Address
First Line	:	6900 W I 40 STE 180
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79106-2522
Country	:	US
Telephone Number	:	806-738-3456
Fax Number	:	806-214-3417

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

Provider Enumeration Date	:	06/28/2020
Last Update Date	:	09/12/2024

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