Provider Demographics
NPI:1639363104
Name:GILYARD, KIMBLYN LASHUN (RN, LMT,MMP)
Entity Type:Individual
Prefix:MISS
First Name:KIMBLYN
Middle Name:LASHUN
Last Name:GILYARD
Suffix:
Gender:F
Credentials:RN, LMT,MMP
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:LASHUN
Other - Last Name:GILYARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7410 BLANCO RD
Mailing Address - Street 2:STE 104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-4363
Mailing Address - Country:US
Mailing Address - Phone:210-861-7828
Mailing Address - Fax:
Practice Address - Street 1:7410 BLANCO RD
Practice Address - Street 2:STE 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4363
Practice Address - Country:US
Practice Address - Phone:210-861-7828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX582524163W00000X, 163WH0200X, 163WH1000X, 163WW0000X, 163WC1500X, 163WP0000X, 163WS0121X
TXMT040302163WM1400X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No163W00000XNursing Service ProvidersRegistered Nurse
No174400000XOther Service ProvidersSpecialist
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery