MEDICARE: KIMBERLY LONDON FNP-C

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	1087478	TX

General Provider Information

NPI Number	:	1669100079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY LONDON FNP-C

Provider Business Mailing Address
First Line	:	902 KITTY HAWK RD STE 170616
Second Line	:
City	:	UNIVERSAL CITY
State	:	TX
Zip	:	78148-3825
Country	:	US
Telephone Number	:	910-823-6201
Fax Number	:

Provider Business Practice Location Address
First Line	:	902 KITTY HAWK RD STE 170616
Second Line	:
City	:	UNIVERSAL CITY
State	:	TX
Zip	:	78148-3825
Country	:	US
Telephone Number	:	910-823-6201
Fax Number	:

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

Provider Enumeration Date	:	08/12/2022
Last Update Date	:	08/12/2022

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Directions to “ KIMBERLY LONDON FNP-C” Practice Location

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