Provider Demographics
NPI:1679655567
Name:ANDERSON, ANTOINETTE KIMERER (CNM)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:KIMERER
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5737 CULLEN BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-1665
Mailing Address - Country:US
Mailing Address - Phone:813-440-7313
Mailing Address - Fax:
Practice Address - Street 1:5737 CULLEN BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-1665
Practice Address - Country:US
Practice Address - Phone:813-440-7313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX439129176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX036804502Medicaid
TX090047401Medicaid
TN439129OtherLICENSE
TX86N732OtherBCBS
TX090047401Medicaid