Provider Demographics
NPI:1790203016
Name:KIMUYU, TIMOTHY (APRN)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:KIMUYU
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 RIVER BEND DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-6943
Mailing Address - Country:US
Mailing Address - Phone:214-743-1272
Mailing Address - Fax:
Practice Address - Street 1:1024 E BROAD ST
Practice Address - Street 2:STE 207
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7702
Practice Address - Country:US
Practice Address - Phone:682-518-3333
Practice Address - Fax:682-518-3323
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134997363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health