Provider Demographics
NPI:1700837044
Name:COLEMAN-HENDERSON, KIMBERLEE A (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLEE
Middle Name:A
Last Name:COLEMAN-HENDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E UNIVERSITY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-6814
Mailing Address - Country:US
Mailing Address - Phone:512-868-1124
Mailing Address - Fax:
Practice Address - Street 1:3950 N A W GRIMES BLVD
Practice Address - Street 2:BUILDING 2
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-3540
Practice Address - Country:US
Practice Address - Phone:877-800-5722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME146906207V00000X
GA0057591207V00000X
TXN4358207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207600202Medicaid
TX207600201Medicaid
TX2076002-03Medicaid
TX207600202Medicaid
TXP00847943Medicare PIN
TX207600201Medicaid