Provider Demographics
NPI:1902021850
Name:HILMER, KIMBERLY A (FNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:HILMER
Suffix:
Gender:F
Credentials:FNP
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 761
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-0761
Mailing Address - Country:US
Mailing Address - Phone:817-372-9200
Mailing Address - Fax:877-515-5209
Practice Address - Street 1:5700 E I-20 SERVICE RD SOUTH
Practice Address - Street 2:#100
Practice Address - City:ALEDO
Practice Address - State:TX
Practice Address - Zip Code:76008-5115
Practice Address - Country:US
Practice Address - Phone:817-489-7300
Practice Address - Fax:817-489-7302
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX617313363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167844302Medicaid
TXTXB112223Medicare PIN
8C1673Medicare ID - Type UnspecifiedPROVIDER NUMBER
Q05747Medicare UPIN