Provider Demographics
NPI:1407502990
Name:PEREZ, KYMBERLY ROSE (FNP)
Entity Type:Individual
Prefix:
First Name:KYMBERLY
Middle Name:ROSE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13725 NORTHWEST BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-5124
Mailing Address - Country:US
Mailing Address - Phone:361-387-9413
Mailing Address - Fax:361-387-9616
Practice Address - Street 1:13725 NORTHWEST BLVD STE A
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-5124
Practice Address - Country:US
Practice Address - Phone:361-387-9413
Practice Address - Fax:361-387-9616
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1050455363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily