Provider Demographics
NPI:1215366562
Name:WILLHOITE, KIMBERLY
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:WILLHOITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:MCMANUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2345 CHIMNEY ROCK RD
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-2616
Mailing Address - Country:US
Mailing Address - Phone:512-552-1879
Mailing Address - Fax:
Practice Address - Street 1:1001 E UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-6100
Practice Address - Country:US
Practice Address - Phone:512-863-1252
Practice Address - Fax:512-863-1310
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX772774163WC1400X
TXAP130266363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC1400XNursing Service ProvidersRegistered NurseCollege Health