Provider Demographics
NPI:1033421383
Name:BERG, KIMBERLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLEY
Middle Name:
Last Name:BERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KIMBERLEY
Other - Middle Name:
Other - Last Name:GERARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1924 PINE ST STE 401
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2451
Mailing Address - Country:US
Mailing Address - Phone:325-676-0557
Mailing Address - Fax:
Practice Address - Street 1:1924 PINE ST STE 401
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2451
Practice Address - Country:US
Practice Address - Phone:325-676-0557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2023-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1033421383208000000X, 2080N0001X
AZR72238208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208600000XAllopathic & Osteopathic PhysiciansSurgery