Provider Demographics
NPI:1467131789
Name:BRACEY, KIMBERLY SUZANN (RN)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:SUZANN
Last Name:BRACEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:SUZANN
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:8942 PEMBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-0090
Mailing Address - Country:US
Mailing Address - Phone:104-442-2402
Mailing Address - Fax:
Practice Address - Street 1:8942 PEMBRIDGE WAY
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-0090
Practice Address - Country:US
Practice Address - Phone:210-442-2402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1027822163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse