Provider Demographics
NPI:1598964009
Name:KIMBALL, MICHELLE K (ANP-BC)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:K
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:K
Other - Last Name:JONES-KIMBALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:1300 W. TERRELL #500
Mailing Address - Street 2:CONSULTANTS IN CARDIOLOGY, PA
Mailing Address - City:FT. WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2810
Mailing Address - Country:US
Mailing Address - Phone:817-252-5000
Mailing Address - Fax:817-252-5060
Practice Address - Street 1:1300 W TERRELL #500
Practice Address - Street 2:
Practice Address - City:FT. WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2810
Practice Address - Country:US
Practice Address - Phone:817-252-5000
Practice Address - Fax:817-252-5060
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP107871363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB118319Medicare PIN
TX533008YKPWMedicare PIN
TXTXB144755Medicare PIN
P26230Medicare UPIN