Provider Demographics
NPI:1578296547
Name:NOVICKE, KIMBERLY
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:NOVICKE
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 1:763 PHILLIPSBURG CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CHAPPELL HILL
Mailing Address - State:TX
Mailing Address - Zip Code:77426-3829
Mailing Address - Country:US
Mailing Address - Phone:281-451-3855
Mailing Address - Fax:
Practice Address - Street 1:763 PHILLIPSBURG CHURCH RD
Practice Address - Street 2:
Practice Address - City:CHAPPELL HILL
Practice Address - State:TX
Practice Address - Zip Code:77426-3829
Practice Address - Country:US
Practice Address - Phone:281-451-3855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX799779163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency