Provider Demographics
NPI:1497994453
Name:STEPHENS, KIMBERLY (RN)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 HEATHGATE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-2618
Mailing Address - Country:US
Mailing Address - Phone:281-480-2273
Mailing Address - Fax:281-463-2103
Practice Address - Street 1:703 HEATHGATE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-2618
Practice Address - Country:US
Practice Address - Phone:281-480-2273
Practice Address - Fax:281-463-2103
Is Sole Proprietor?:No
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX608101171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator