Provider Demographics
NPI:1568411684
Name:EDEN, KIMBERLY T (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:T
Last Name:EDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5701 BRYANT IRVIN RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4029
Mailing Address - Country:US
Mailing Address - Phone:817-361-6200
Mailing Address - Fax:817-361-6201
Practice Address - Street 1:5701 BRYANT IRVIN RD
Practice Address - Street 2:SUITE 301
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4029
Practice Address - Country:US
Practice Address - Phone:817-361-6200
Practice Address - Fax:817-361-6201
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7726207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143777402Medicaid
TX8706B6OtherBCBS
TX080180172Medicare PIN
TX8706B6Medicare PIN
TX143777402Medicaid