Provider Demographics
NPI:1548760390
Name:CASON, KIMBERLY ANN
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:CASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1664 COUNTY ROAD 2325
Mailing Address - Street 2:
Mailing Address - City:TELEPHONE
Mailing Address - State:TX
Mailing Address - Zip Code:75488-4624
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1664 COUNTY ROAD 2325
Practice Address - Street 2:
Practice Address - City:TELEPHONE
Practice Address - State:TX
Practice Address - Zip Code:75488-4624
Practice Address - Country:US
Practice Address - Phone:903-640-3763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX695911163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX695911Medicaid