MEDICARE: KIMBERLY DAVONG FNP-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	363LF0000X	Family Nurse Practitioner	AP127472	TX

General Provider Information

NPI Number	:	1437541794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY DAVONG FNP-BC

Provider Business Mailing Address
First Line	:	1575 I 30
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75150-6905
Country	:	US
Telephone Number	:	469-800-2800
Fax Number	:	469-800-2801

Provider Business Practice Location Address
First Line	:	7406 W STATE HIGHWAY 66
Second Line	:
City	:	ROYSE CITY
State	:	TX
Zip	:	75189-4166
Country	:	US
Telephone Number	:	972-460-4422
Fax Number	:

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

Provider Enumeration Date	:	02/24/2015
Last Update Date	:	04/01/2022

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