Provider Demographics
NPI:1003814294
Name:MORGAN, KIMBERLY K (APN)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:K
Last Name:MORGAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:K
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:2466 LADD ST BLDG 3742
Mailing Address - Street 2:
Mailing Address - City:JBSA LACKLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78236-5310
Mailing Address - Country:US
Mailing Address - Phone:972-529-0480
Mailing Address - Fax:
Practice Address - Street 1:1100 WILFORD HALL LOOP
Practice Address - Street 2:
Practice Address - City:JBSA LACKLAND
Practice Address - State:TX
Practice Address - Zip Code:78236-5638
Practice Address - Country:US
Practice Address - Phone:210-925-8318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP110132363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193500OtherAMERIGROUP CORPORATION
TX15443OtherPARKLAND COMMUNITY HEALTH
TX160218702Medicaid
TX864N60OtherBCBS
TX8N8563OtherBLUE SHIELD OF TEXAS
TXP12458Medicare UPIN
TX8C9995Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE
TX334038YKQLMedicare PIN
TX8J7605Medicare PIN
TX334038YKP5Medicare PIN
TX160218702Medicaid