Provider Demographics
NPI:1154864742
Name:MIDDLETON, KIMBERLY ELAINE (NP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ELAINE
Last Name:MIDDLETON
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 1:4211 JOE RAMSEY BLVD E STE 105
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-7858
Mailing Address - Country:US
Mailing Address - Phone:214-369-3613
Mailing Address - Fax:903-408-7919
Practice Address - Street 1:4211 JOE RAMSEY BLVD E STE 105
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401
Practice Address - Country:US
Practice Address - Phone:214-369-3613
Practice Address - Fax:903-408-7919
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX616441363L00000X
TXAP132579363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX616441OtherREGISTERED NURSE LICENSE