Provider Demographics
NPI:1639704257
Name:GUAJARDO, KIMBERLY ANN (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:GUAJARDO
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:RAMOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN, FNP-C
Mailing Address - Street 1:PO BOX 4585, MSC#700
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4585
Mailing Address - Country:US
Mailing Address - Phone:210-625-4733
Mailing Address - Fax:210-625-4734
Practice Address - Street 1:12709 TOEPPERWEIN RD STE 101
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3259
Practice Address - Country:US
Practice Address - Phone:210-625-4733
Practice Address - Fax:210-625-4734
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144558363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner