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NPI Code Detail

MEDICARE: TIMOTHY KIMUYU APRN

MEDICARE: TIMOTHY KIMUYU APRN
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAP134997TX

General Provider Information

NPI Number : 1790203016
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY KIMUYU APRN
Provider Business Mailing Address
First Line : 1345 RIVER BEND DR
Second Line :
City : DALLAS
State : TX
Zip : 75247-6943
Country : US
Telephone Number : 214-743-1272
Fax Number :
Provider Business Practice Location Address
First Line : 1024 E BROAD ST
Second Line : STE 207
City : MANSFIELD
State : TX
Zip : 76063-7702
Country : US
Telephone Number : 682-518-3333
Fax Number : 682-518-3323
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2017
Last Update Date : 04/15/2019

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