MEDICARE: TRESTER FAMILY MEDICAL GROUP

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	633384	TX
2	207R00000X	Internal Medicine Physician	F4313	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0056MS	OTHER	TX	BC/BS ID NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457465486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRESTER FAMILY MEDICAL GROUP

Provider Business Mailing Address
First Line	:	900 E PARK BLVD
Second Line	:	SUITE 280
City	:	PLANO
State	:	TX
Zip	:	75074-5465
Country	:	US
Telephone Number	:	972-424-7000
Fax Number	:	972-424-7001

Provider Business Practice Location Address
First Line	:	900 E PARK BLVD
Second Line	:	SUITE 280
City	:	PLANO
State	:	TX
Zip	:	75074-5465
Country	:	US
Telephone Number	:	972-424-7000
Fax Number	:	972-424-7001

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. KIMBERLY KEEN TRESTER III
Credential	:	NP
Telephone Number	:	972-424-7000

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	09/11/2025

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Directions to “TRESTER FAMILY MEDICAL GROUP ” Practice Location

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