Provider Demographics
NPI:1003162454
Name:BYRUM, KIMBERLY FUGMAN (FNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:FUGMAN
Last Name:BYRUM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17902 THEISSWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-3985
Mailing Address - Country:US
Mailing Address - Phone:281-723-7299
Mailing Address - Fax:
Practice Address - Street 1:13802 CENTERFIELD RD
Practice Address - Street 2:SUITE 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-6044
Practice Address - Country:US
Practice Address - Phone:281-737-0999
Practice Address - Fax:281-737-0926
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX669375363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX305066802Medicaid
TX1003162454OtherBLUE CROSS BLUE SHIELD
TX8365NDOtherBLUE CROSS BLUE SHIELD
TX305066803Medicaid
TX1003162454OtherBLUE CROSS BLUE SHIELD
TX305066803Medicaid