Provider Demographics
NPI:1144231564
Name:CHRISTY, KIMBERA MILLS (NP)
Entity Type:Individual
Prefix:MS
First Name:KIMBERA
Middle Name:MILLS
Last Name:CHRISTY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 COUNTY ROAD 109
Mailing Address - Street 2:
Mailing Address - City:RIESEL
Mailing Address - State:TX
Mailing Address - Zip Code:76682-3715
Mailing Address - Country:US
Mailing Address - Phone:254-896-3901
Mailing Address - Fax:
Practice Address - Street 1:4800 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76711-1329
Practice Address - Country:US
Practice Address - Phone:254-297-3133
Practice Address - Fax:254-297-5377
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX571387363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care