Provider Demographics
NPI:1215194006
Name:ZILSKE, KIMBERLY SUE (NP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SUE
Last Name:ZILSKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:SUE
Other - Last Name:POOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:6431 FANNIN STREET
Mailing Address - Street 2:MSB 1.282
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-500-6838
Mailing Address - Fax:713-500-6829
Practice Address - Street 1:6431 FANNIN ST
Practice Address - Street 2:MSB 1.282
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-500-6838
Practice Address - Fax:713-500-6829
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122377363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1538397120OtherGROUP NPI
MI270381199OtherGROUP TAX ID
MI1538397120OtherGROUP NPI