Provider Demographics
NPI:1104023431
Name:KINSELLA, KIMBERLY KATHRYN (RN)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:KATHRYN
Last Name:KINSELLA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14258 FM 2769
Mailing Address - Street 2:
Mailing Address - City:VOLENTE
Mailing Address - State:TX
Mailing Address - Zip Code:78641-9130
Mailing Address - Country:US
Mailing Address - Phone:512-219-0949
Mailing Address - Fax:
Practice Address - Street 1:14258 FM 2769
Practice Address - Street 2:
Practice Address - City:VOLENTE
Practice Address - State:TX
Practice Address - Zip Code:78641-9130
Practice Address - Country:US
Practice Address - Phone:512-219-0949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX458968163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse