Provider Demographics
NPI:1821158015
Name:KIMMONS, BARBARA JEAN (PAC)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:JEAN
Last Name:KIMMONS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 73627
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77273-3627
Mailing Address - Country:US
Mailing Address - Phone:281-444-3278
Mailing Address - Fax:832-249-3850
Practice Address - Street 1:17350 ST. LUKES WAY
Practice Address - Street 2:SUITE 400
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-4167
Practice Address - Country:US
Practice Address - Phone:281-444-3278
Practice Address - Fax:832-249-3850
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02286207V00000X, 363AM0700X
FLPA9103607207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS70867Medicare UPIN
8L1296Medicare UPIN