Provider Demographics
NPI:1215372156
Name:KIMBERLY M CARPIN, MD, PLLC
Entity Type:Organization
Organization Name:KIMBERLY M CARPIN, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARPIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-333-4600
Mailing Address - Street 1:2020 NASA PKWY
Mailing Address - Street 2:SUITE 260
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3683
Mailing Address - Country:US
Mailing Address - Phone:281-333-4600
Mailing Address - Fax:281-333-9455
Practice Address - Street 1:2020 NASA PKWY
Practice Address - Street 2:SUITE 260
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3683
Practice Address - Country:US
Practice Address - Phone:281-333-4600
Practice Address - Fax:281-333-9455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8082208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX329844001Medicaid
TX329844001Medicaid