Provider Demographics
NPI:1780205427
Name:PRINCE, KIMBERLY DENISE (APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DENISE
Last Name:PRINCE
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 E MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5602
Mailing Address - Country:US
Mailing Address - Phone:903-758-2610
Mailing Address - Fax:903-212-7689
Practice Address - Street 1:1107 E MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5602
Practice Address - Country:US
Practice Address - Phone:903-758-2610
Practice Address - Fax:903-212-7689
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145974363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP145974OtherTEXAS BOARD OF NURSES