MEDICARE: MS. MICHELLE K. KIMBALL ANP-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	363LA2200X	Adult Health Nurse Practitioner	AP107871	TX

General Provider Information

NPI Number	:	1598964009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE K. KIMBALL ANP-BC

Provider Business Mailing Address
First Line	:	1300 W. TERRELL #500
Second Line	:	CONSULTANTS IN CARDIOLOGY, PA
City	:	FT. WORTH
State	:	TX
Zip	:	76104-2810
Country	:	US
Telephone Number	:	817-252-5000
Fax Number	:	817-252-5060

Provider Business Practice Location Address
First Line	:	1300 W TERRELL #500
Second Line	:
City	:	FT. WORTH
State	:	TX
Zip	:	76104-2810
Country	:	US
Telephone Number	:	817-252-5000
Fax Number	:	817-252-5060

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

Provider Enumeration Date	:	07/13/2007
Last Update Date	:	03/04/2022

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