Provider Demographics
NPI:1114947603
Name:MONNIN, KIMBERLY A (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:A
Last Name:MONNIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 WALL ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-4534
Mailing Address - Country:US
Mailing Address - Phone:512-375-1275
Mailing Address - Fax:512-873-5004
Practice Address - Street 1:9200 WALL ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-4534
Practice Address - Country:US
Practice Address - Phone:512-375-1275
Practice Address - Fax:512-873-5004
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83665174400000X
TXL7817207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX311355701Medicaid
CA00A836650Medicaid
CAP00050739Medicare UPIN
H80829Medicare ID - Type Unspecified
TX311355701Medicaid
CA00A836650Medicare UPIN
TXTXB162437Medicare PIN