Provider Demographics
NPI:1255328241
Name:TROUTMAN, KIM-MARIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:KIM-MARIE
Middle Name:
Last Name:TROUTMAN
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 1:17376 NORTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:JERSEY VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:77040-1114
Mailing Address - Country:US
Mailing Address - Phone:713-466-0197
Mailing Address - Fax:
Practice Address - Street 1:17376 NORTHWEST FWY
Practice Address - Street 2:
Practice Address - City:JERSEY VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:77040-1114
Practice Address - Country:US
Practice Address - Phone:713-466-0197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX652747363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83C8189Medicare ID - Type Unspecified
Q28708Medicare UPIN